1
StanleyLigas,etal.v.FeliciaNorwood,etal.
FifthAnnualReportoftheMonitorJanuary20,2017
INTRODUCTION
ThisreportisrespectfullysubmittedtotheCourt,thePartiesandtheIntervenors
inaccordancewith¶34theLigasConsentDecree(Decree),whichwasapproved
andfiledbytheCourtonJune15,2011.TheDecreerequiresthat:
“TheMonitor shall file annual reports to the Court, which shall beserved on all Parties and Intervenors and shall be made publiclyavailable.Suchreportsshallincludetheinformationnecessary,intheMonitor’s professional judgement, for the Court, Plaintiffs andIntervenors to evaluate Defendants’ compliance or non-compliancewiththetermsoftheDecree.”
The first LigasMonitor, Tony Records,was appointed by the Court on July 19,
2011.Uponhisretirement,thecurrentMonitor’sappointmentwaseffectiveon
July1,2015. The first threeAnnualReportsof theMonitorwere submittedby
Mr. Records on September 27, 2012; September 30, 2013 and September 30,
2014.BaseduponthetimingofthecurrentMonitor’sappointmentinJuly,2015,
the reporting schedulewas changed to January, 2016 to allow theMonitor six
monthsforaninitialevaluationoftheDefendants’compliancewiththetermsof
theDecree.TheFourthAnnualReportwasfiledwiththeCourtanddistributedto
the Parties and Intervenors on January 7, 2016. It was subsequently made
availableontheDHSwebsiteanddistributedwidely.
Case: 1:05-cv-04331 Document #: 646 Filed: 01/20/17 Page 1 of 57 PageID #:12232
2
The ongoing cooperation of the Defendants, Plaintiffs’ counsel and
representatives, counsel for the Intervenors, service providers, advocacy
organizations,familyassociationsandotherstoonumeroustomentionhasbeen
invaluable incompleting thecurrent report. Input fromthoseprotectedby the
Decree and their families remains critical to theMonitor’s efforts on an almost
dailybasis aswell asduring annual evaluationsof theDecree’s effectiveness at
eachstageofitsimplementation.
Case: 1:05-cv-04331 Document #: 646 Filed: 01/20/17 Page 2 of 57 PageID #:12233
3
CHALLENGES
TheMonitor’sFourthAnnualReportcitesthelackofaStatebudgetforFiscalYear
(FY) 2016 in Illinois and describes in detail how funding was guaranteed for
providers serving all of those protected by the Consent Decree. It is stated
thereinthatthelackofabudgetfortheStateofIllinoisresultedinuncertainties
for beneficiaries of the Consent Decree and their families, agencies, advocates,
staffandprovidersofalltypesofservices.FederalCourtorderstoaddressthese
issues are quoted therein and the Monitor’s requirement of monthly updates
fromDHSregardingtimelinessofsuchpaymentsisreferenced.This“Information
Request Regarding Ligas Payments” remains in effect. In light of the lack of a
State budget for FY17, which continues to date, the Plaintiffs, Defendants and
Intervenors prepared an “Agreed Order to Maintain Compliance with Consent
Decree”and filedwith theCourton6/26/16a JointMotion toApproveAgreed
Order. This Order, which was approved by United States District Judge Sharon
JohnsonColemanon6/27/16andenteredon6/28/16requires,inpart,that:
“The Comptroller shall continue to timely approve and makepayments for all services, programs and personnel, at a level andwithinthetimeperiodthatsuchpaymentsweremadeinFiscalYear2016, that are necessary to comply with the Consent Decree andImplementationPlans. TheCourtspreviousordersofJune30,2015(Dkt.#597),August18,2015(Dkt.#610)andSeptember1,2015(Dkt.#624) are incorporated herein and shall continue in effect. ThisOrdershall remain ineffectuntil theearlieroftheeffectivedateoftheFiscalYear2017budgetorJuly1,2017,oruntilfurtherorderofthisCourt.”
Case: 1:05-cv-04331 Document #: 646 Filed: 01/20/17 Page 3 of 57 PageID #:12234
4
“The Illinois Department of Healthcare and Family Services, theDepartment of Human Services, and the Illinois State Comptrollershall provide such information to the CourtMonitor on amonthlybasis to enable her to evaluate and to advise the Court and theParties regarding the State’s compliance with the Consent DecreeandOrdersenteredbythisCourt.”“IfatanytimetheStatebelievesthat itmaynotbeabletocomplywith any provision of the Consent Decree or this Order, the Statemust immediatelybringtheState’spotentialnon-compliancetotheattentionoftheCourt,theMonitor,thePlaintiffsandtheIntervenorsbeforesuchnon-complianceoccurs.”“TheStateshallmaintainitsexpeditedpaymentsconsistentwiththetermsandconditionsthatexistedduringFY2015.”
Todate,Defendantshavemaintained fundingat thesame levelpaid inFY2016
which, thoughnoted tobe inadequate in the FourthAnnualReport, remains in
compliancewiththe6/28/16CourtOrder.
The Monitor’s Fourth Annual Report addresses the fact that low wages,
particularly those paid to Direct Support Professionals (DSPs), resulted in a
staffingcrisisforprovidersofservicesintheireffortstorecruit,trainandmaintain
adequate staffing with the existing wages. There has been a great deal of
discussionatalllevelsduringthepastyearwithoutimprovementinthissituation.
Thestaffingcrisiscontinuesasanotheryearhaspassedwithnoreliefintermsof
salaryincreases,DSPvacancyrateseitherstayingthesameorincreasingandthe
Case: 1:05-cv-04331 Document #: 646 Filed: 01/20/17 Page 4 of 57 PageID #:12235
5
heightening impact of no increases in rates to providers since 2008 combined
withongoinghighercostsofoperating.
The Monitor’s Fourth Annual Report describes delays in initiation of waiver
services for class members once they have been selected from the PUNS list.
Herein it is noted that a new tracking system has been developed to actively
monitorthoseclassmembersseekingservices.
TheMonitor’s Fourth Annual Report notes limited availability of small CILAs in
some geographic areas as well as for individuals with more intense medical,
behavioralorphysicalneeds.TheMonitorhasbeen informedduringFiscalYear
17thatthissituationisworseningasnewCILAdevelopmentisbeingdelayeddue
to lack of availability of DSPs willing to accept current wages and that some
existingsmallCILAsareatriskofeitherclosingorbeingconsolidated into larger
homes due to staff turnover rates of up to 70%. Some providers are actually
stating that they are no longer able to accept into their CILAs individuals with
more significant needs due to the provider agencies’ inability to recruit,
repeatedlyretrain(atsignificantcost)andconsistentlymaintainsufficientlyskilled
stafftoservetheseindividuals.
TheMonitor’sFourthAnnualReportdiscusses inadequateavailabilityofflexible,
person-centered, integrateddayactivitiesoremploymentfor individualsseeking
suchopportunities,allofwhichremainsproblematic.Effortshavebegunthrough
theEmploymentFirst initiativethatappeartobepromisingbut it istoosoonto
Case: 1:05-cv-04331 Document #: 646 Filed: 01/20/17 Page 5 of 57 PageID #:12236
6
evaluatetheoutcomes.Inadditionthedaytrainingrequirementforthoseliving
inCILAs isadeterrent to those individuals looking forhomes in thecommunity
but preferring other daytime activities that are more customized and/or
integratedintothecommunity.
TheMonitor’sFourthAnnualReportnotesthatdespitetheDefendants’ongoing
commitment tocompliancewith theConsentDecree, thepreviousMonitorhad
expressedconcernthatresourcesforimplementationare“significantlystrained”
and that “if not effectively addressed could result in non-compliance”. The
current Monitor’s finding, in January, 2016, of non-compliance with regard to
ResourcesandCapacityisrepeatedherein.(SeesectionIbelow.)
The Monitor has initiated conversations with the Division of Developmental
Disabilities(DDD)withintheDepartmentofHumanServices(DHS)regardingthe
processesutilized tomonitor thequalityof servicesprovided tobeneficiariesof
the Consent Decree. Information requests were submitted to DDD and all
documentswerepromptlyprovided.DiscussionsareongoingamongtheMonitor
andtheParties.(SeesectionI.ResourcesandCapacity)
Case: 1:05-cv-04331 Document #: 646 Filed: 01/20/17 Page 6 of 57 PageID #:12237
7
OVERALLIMPLEMENTATIONACTIVITIES
TheMonitorhas,over thepastyear, soughtandalso receivedunsolicited input
regardingmanyaspectsoftheimplementationoftheLigasConsentDecree.Such
activitiesareconsistentwiththeDecree’sComplianceEvaluationStandardswhich
state,inpart:
“On an ongoing basis, the Monitor will seek and encourage classmembers, families and guardians of class members, the privateprovider community andmembersof the general public to providewrittenandverbalfeedbackonissuesrelatedtocompliancewiththeDecree. Informal meetings and conference calls will also beconducted with defendants’ counsel and staff, class counsel andintervenors’counselregardingtheirrespectiveexperiencesaswellasinformationtheymayhavewithregardtocomplianceactivities.”
TheMonitor’simplementationactivitiesoverthepastyearincluded:
• Communicating regularly with the Defendants, Plaintiffs andIntervenors;
• Conveningmore frequent Parties’ meetings than had previously beenthepracticeinordertoaddressthemostcriticalissuesimpactingthoseprotected by the Consent Decree as well as to attempt to reachconsensuson thedevelopmentof theLigas ImplementationPlan2016Revisions;
• Conveningmeetingstoaddressthe“ReasonablePace”provisionoftheConsent Decree which is scheduled to become effective on June 15,2017;
• Reviewing data and other information provided by the Defendants atagreeduponintervalsaswellasonamorefrequentbasisasrequestedbytheMonitor;
Case: 1:05-cv-04331 Document #: 646 Filed: 01/20/17 Page 7 of 57 PageID #:12238
8
• Reviewinghundredsof documents providedbyClass Counsel, Counselfor the Intervenors, service providers, Independent SupportCoordination(ISC)agencies,advocacyorganizationsandindividuals;
• Participating in Status Conferences, which are currently being heldapproximately every 60 days, with Judge Coleman, Defendants, ClassCounselandCounselfortheIntervenors;
• Meeting with members of the management team and staff at theDivision of Development Disabilities (DDD) within the Department ofHumanServices(DHS);
• Participating in monthly conference calls with Plaintiffs’ Counsel andDefendantsregardingindividualclassmemberissues;
• Responding promptly to frequent inquiries from class members andtheirfamilies,guardiansandadvocates;
• Presenting information regarding Ligas matters to large and smallgroups of parents, ISCs, service providers, provider organizations,advocates, the Ligas Class Member/ Family Advisory Council, and theLigasFamilyAdvocacyProgram;
• Participating inapanelconvenedby theSenateCommitteeonHumanServicestoaddressthestatusandfutureofthe implementationoftheLigasConsentDecree;
• Visitingindividualswheretheylive,workandattendprograms;• Initiating numerous conference calls with Defendants, Plaintiffs and
Intervenorstoaddresssignificantissuesonatimelybasis;• InitiatingadiscussionwiththeDevelopmentalDisabilitiesDivision(DDD)
of the Department of Human Services (DHS) regarding the overallqualitymonitoringof IndependentSupportCoordination (ISC)agenciesandCommunityIntegratedLivingArrangements(CILAs);and
• Addressing,inavarietyofways,theimpactuponthoseprotectedbytheConsentDecreeoftheState’soverallfiscalcrisisandthespecificissueofinadequatewagesforDirectSupportProfessionals.
Case: 1:05-cv-04331 Document #: 646 Filed: 01/20/17 Page 8 of 57 PageID #:12239
9
The Defendants continue to engage in actions required by the Consent DecreeandLigasImplementationPlanthroughsuchactivitiesas:
• MeetingornumericallyexceedingtheConsentDecree’sbenchmarksforinitiatingservicesforclassmembersonthewaitinglistaswellasthoselivinginICFs/DD;
• Responding promptly and comprehensively to information requestsfromtheMonitor;
• Participating in issue specific conference calls and videoconferencesinitiatedbytheMonitorbeyondthosewhicharescheduledonaroutinebasis;
• ParticipatinginmonthlyconferencecallswiththeMonitorandEquipforEquality (EFE) regarding individual Class member issues as well aspromptly following up on individual Class member issues broughtdirectly to DDD by the Monitor in response to contacts from familymembersandguardians;
• ConductingreviewsofalloftheISCagenciesandasampleoftheCILAsonanannualbasisaswellasrespondingtotheMonitor’s requests foradditionalinformationregardingtheprocessesandprotocolsinvolvedinthissystem;
• Maintaining agreed upon data required to assess compliancewith theConsentDecree;
• Participating in a cooperative, though eventually unsuccessful, effortwith thePlaintiffs, IntervenorsandMonitor to reachconsensuson thecontentof the2016Revisionsof the Ligas Implementation inorder tocontinuethepracticeoffiling jointlywiththeCourtthe2016RevisionsoftheLigasImplementationPlan;
• Recentlydeveloping,withinputfromthePlaintiffsandMonitor,amorecomprehensivelistofthosewhohavebeenselectedtoreceiveservicesfromthePrioritizationofUrgencyofNeedforServices(PUNS)databaseandarestillseekingservices;and
• Organizing and participating in quarterly meetings of the Ligas ClassMember/FamilyAdvisoryCommittee.
Case: 1:05-cv-04331 Document #: 646 Filed: 01/20/17 Page 9 of 57 PageID #:12240
10
The Ligas Class Member/ Family Advisory Committee was established in
compliancewith the2013Revisionof theLigas ImplementationPlanandmeets
quarterly at two locations which are connected by videoconferencing and
telephone. DDD staff, Class counsel, the Monitor, family advocates and self-
advocates regularly attend these meetings and guest speakers are invited to
meetingsuponrequestofthemembersorassuggestedbyDDDortheMonitor.
The Monitor finds these meetings to be informative and brings questions,
concernsaswellassuggestionsfromthesemeetingstoothersasnecessary.
Case: 1:05-cv-04331 Document #: 646 Filed: 01/20/17 Page 10 of 57 PageID #:12241
11
COMPLIANCEREQUIREMENTSANDACTIVITIES
Pursuant to¶32of theConsentDecree, Compliance Evaluation Standardswere
finalized in July 2012 to provide “objective standards to guide the Monitor in
evaluating the Defendants’ compliance with the Decree.” The Ligas
ImplementationPlan,asrequiredby¶29oftheDecree,“issupplementaltothe
ConsentDecreeandtheMonitorthereforealsoreportsonactivitiesspecified in
the Implementation Plan as they relate to each of the following Compliance
EvaluationStandards:
I. ResourcesandCapacityII. ClassMemberList(s)III. TransitionServicePlansIV. TransitionforClassMembersinICFs/DDV. CrisisServicesVI. TransitionforClassMembersonWaitingListVII. OutreachVIII. ImplementationPlanIX. DataReports
AsnotedintheFourthAnnualReportoftheMonitor,whileeachoftheseareasof
complianceisaddressedseparatelyinthefollowingsectionsofthecurrentreport,
more attention is given to the areas which currently have the greatest impact
uponthoseprotectedbytheConsentDecree.
Case: 1:05-cv-04331 Document #: 646 Filed: 01/20/17 Page 11 of 57 PageID #:12242
12
I. ResourcesandCapacity
Paragraph4oftheConsentDecreerequires,inpart:
“Defendants shall implement sufficient measures to ensure theavailability of services, supports and other resources of sufficientquality, scope and variety to meet their obligations to suchIndividualsundertheDecreeandtheImplementationPlan…”
“Funding for services for each Individual with DevelopmentalDisabilities will be based on the Individual’s needs using federallyapproved objective criteria regardless of whether the Individualchooses to receive services in an ICF-DD or in a Community-Basedsetting…”
Paragraph5oftheDecreerequires,inpart:
“Annual budgets submitted by Defendants on behalf of theiragencies shall request sufficient funds necessary to develop andmaintain the services, supports and structures described in theDecree, consistent with the choices of Individuals withDevelopmental Disabilities, including Class Members. Defendantsshall take steps sufficient to implement funding mechanisms thatfacilitatetransitionamongservicesettings.”
Inaddition,theComplianceEvaluationStandardsindicatethat:
“Thedefendantswill provide theproposed annual budget and costassumptions to the parties, intervenor and Monitor that specifyspending plans for all activities related to compliance with theDecree in sufficient detail to permit an evaluation of Defendants’compliancewiththeDecree.”
Case: 1:05-cv-04331 Document #: 646 Filed: 01/20/17 Page 12 of 57 PageID #:12243
13
For Fiscal Year 2017, the second consecutive year, there is no approved State
Budgetandnoassurancethatthisimpassewillberesolvedwithinthesecondhalf
of Fiscal Year 2017. The Implementation Plan 2016 Revisions document
recognizes that Federal Court orders continue to require that all payments be
madefor“allservices,programsandpersonnelforallbeneficiariesoftheConsent
Decree, at a level no less than the levels paid in Fiscal Year 2015, that are
necessarytocomplywiththeConsentDecreeandImplementationPlans”.While
the Defendants continue to complywith theOrders, including providing to the
Monitor monthly reports of payments made, DHS has not provided to the
Monitor, Plaintiffs or Intervenors, or within the 2016 Implementation Plan
Revisions, any indication of how the agencywill be addressing the shortage of
DSPsduetoinadequatewages.
The DHS website includes the 2/17/2016 Illinois Budget Briefing Presentation
which states that “The proposed budget for FY 17 continues to provide critical
servicestothemostvulnerableinIllinois.TheAgencycontinuesitscommitment
torebalancing—movingindividualswithdevelopmentaldisabilities,mentalillness
or physical disabilities out of institutional care and into community settings.”
There is no indication by DHS in the 2016 Implementation Plan Revision that
addresses how this “rebalancing” may be funded or how the staffing crisis in
generalwillbeaddressed.ThisispartofthereasonthatthisImplementationPlan
wasfiledwiththecourtbytheDefendantsalone,withoutajointmotionincluding
thePlaintiffsandIntervenors.
Case: 1:05-cv-04331 Document #: 646 Filed: 01/20/17 Page 13 of 57 PageID #:12244
14
Therefore, as it was during the preparation of the Monitor’s Fourth Annual
Report,itisimpossiblefortheMonitortomakeafindingthatthesufficientfunds
referencedin¶5willbeavailable.
TheFourthAnnualReportincludesdozensofstatementsfromserviceproviders,
families and others detailing not only the fiscal problem causing the
unprecedented staffing shortage in CILAs and ICFs/DD but also its impact upon
thepeoplewholive inthesehomes. Thesestatementsremainrelevantbutwill
notberepeatedhereinastheMonitorhasreceivedadditional,morerecentinput
from countless family members and providers of services and supports to
beneficiariesoftheConsentDecree.Forexample:
“We have consistently run 15% (staff) vacancy rates in Residential DSPopeningssince2008.Thispastyearithasincreasedto25-30%.Wedonothaveenoughstafftomeettheneedsoftheclients.Thisincludesconsistentdifficulty inassistingwith:ADLs (activitiesofdaily living),particularlywithhygiene and cleaning; community access; managing finances. Becausethese needs are not consistently being met, the clients have increasedincidents of maladaptive behaviors and both clients and families aredissatisfiedwithservices.”“Residentshavetogetusedtodifferentstaffintheirhomeeachday.Staffhave to learn all the outcomes, behavior and counseling plans each timetheyareinanewhouse.Thisaffectstheresidentsbecausetheyaren’tabletobuildtrustwithstaffastheyarenotconsistently inthehome.Multiplefamily members and guardians have called with complaints about theinconsistentstaffingandhowthatimpactsthequalityofservices.”
Case: 1:05-cv-04331 Document #: 646 Filed: 01/20/17 Page 14 of 57 PageID #:12245
15
“There have been multiple staff who have left to work at home healthagenciesduetopay.”“WearenotinapositiontoexpandourCILAcapacity.Weareunabletofillthe current shifts we have within our current homes. Taking on morehomeswouldmeanmorevacancies.”“We have closed three CILA homes and sold buildings to reduce costs.Occupancy in 2008 was nine homes with no home having more than 5people.In2015,weoperated6CILAlocations.Occupancyrangesfromfourtoeightpeopleperhouse.”“ForCILAsandICFs,wehave:downsizedstaffingduetolargeyearlydeficit;cut back on community outings; trimmed health insurance coverage.Throughtheadmissionprocess,wehavedeclinedmoredifficultindividualswithmedicalorbehavioralissues.”“Ahugeshortageinstaffingdirectlyimpactstheprogramandthequalityoftime spent with an individual. This situation has created the need toredirect focus tomaintaining personal carewithADLs rather than to skillacquisitionandskillretention.Thisdirectlyimpactstheagency’sabilitytoachieve our mission, goals and overall objective. This truly becomes adisservicetotheindividualsweserve.”“TheworkofaDirectSupportProfessional isbothphysicallyandmentallyexhausting. Whiletheworkcanbeveryrewarding,the impactofstaffingshortagesandmandatoryovertimedoesnotequatetoequalpayforequalwork.Itisfartooeasytofindalessstressfulanddemandingjobpayinganequalorhigherrateofpay.Overthepastyear,thelongtermeffectsofthestate’s failure to increase the rate of pay has created a reduction in ourapplicantpoolandanincreaseinourturnover.”
Case: 1:05-cv-04331 Document #: 646 Filed: 01/20/17 Page 15 of 57 PageID #:12246
16
“Our group homes run with minimal staffing, which does not provideopportunities to promote community integration. Scheduled outings arereducedor foregone. Thisalsocreatesan increasedrisktobothourstaffand individuals. Since thehigh staffing shortages, the agencyhas had toimplement a system for voluntary, and then ultimately mandatory,overtimetocoverallshifts inourgrouphomes. Theextrahoursstaffareworking have the potential to increase mental and physical exhaustion,which ultimately increase the risk of injury or errors with respect topersonalcareandqualityofcare.” “Giventhecurrentresidentialandnursingrates,weareunabletosupportindividuals withmore advanced nursing or behavioral needs.We neitherhavethecommunityresourcesnorsupportstafftoadequatelyaddressandmanagetheseindividuals.”“Staffworkovertimeandextrashiftstomeetbasicneedsandresidentsarenotinthecommunityastheyshouldbe.Lessconsistentcaregiversreducethe quality of care and increase the opportunity for error, particularlymedication administration errors. Lack of consistent staff and individualattention results in less individual goal progress and increasedbehavioralissues.”“Thisorganizationwouldbeclosed in threemonths if itoperatedonlyonwhattheStatecurrentlypaysourorganization.““TotrainaDSPrequiresnotonlycompletingtheDSPcurriculum,butalsoagencyandprogramorientation. Costsaverage$2846.00perpersonpertrainingalone.Thisdoesnotincludeadvertisingandtimespentreviewingand interviewing candidates. With a turnover of 32%, the CILA programhad1/3ofitsstaffmissingduringthelastyear.”“Recentlythestaffwholeftweregood,longertermemployeeswhotoldus
Case: 1:05-cv-04331 Document #: 646 Filed: 01/20/17 Page 16 of 57 PageID #:12247
17
that they left due towages. Therehavebeen several over thepast eightyearswhowereworkingtwojobsandlefttofindonejobthatpaidalivingwage. The reality is that many DSP positions remain open so only basicneeds are being addressed. It is impossible to provide the staff time andindividualizedsupportsnecessaryforbuildingcommunityrelationshipsandemploymentopportunities.”“WehaveexperiencedseveraltimeswhenstaffinghasdroppedsolowthatwewereunabletostaffallofourCILAhomesfortheweekendsandhavehadtoclosesomeofthemtokeepproperstaffingratios.Consumersthenhavetoberelocatedtoanotherhomefortheweekend.”“TheFiscalYear2016reductioninthemonthlypersonalallowanceforCILAresidentshas forcedmost consumers to spendall theirmonthly fundsonmedicalitems,clothingandhygieneproductsleavingnomoneyforleisureactivitiesorhobbieswhichareimportanttotheresident.”“MydaughterhasexperiencedfivetripstotheEmergencyRoomoverthepast eighteen months, is not being provided with the opportunitiesincludedinherISP,hasonlyonestaffmemberonmostshiftstomeettheneedsofall fourwomenwholivetogetherandhavesignificantlydifferinglevelsofneed,andisn’talwaysprovidedwithhealthyfood.”(TheMonitorregularlyaddressessuchconcernswithfamilies,serviceprovidersandDDDstaff.)“DSP turnover rate in our CILA homes is 70.32% over the past twelvemonths.Duetothelargeamountsofovertime,wehavestaffthataretiredandnotatthetopoftheirperformanceabilities.”“Consumer behavior and skill development is directly impacted by therevolving door of staff. Staff barely have a chance to review IndividualSupport Plans or Behavior Plans before they have to move to another
Case: 1:05-cv-04331 Document #: 646 Filed: 01/20/17 Page 17 of 57 PageID #:12248
18
housetofillavacantshiftortheyleave.Weareinaconstantstafftrainingmode.Consumersbecomeconfusedfromhavingtoadapttovariousstaffpersonalitiesandit isalmost impossibletogaintrust inthepersonwhoisresponsibleforassistinginbathing,toileting,etc.Decisionsarefocusedonwhodowehaveateachhouseandwhichstaffingoptionproducestheleastamountofrisktotheconsumerandtheorganization.Itisverydifficulttogobeyondmeeting just theconsumers’basicneedsof food, clothingandshelter.Personcenteredplanningrequiresoneononeinteractionwiththeresident. We try to let residentsmake individual choices, but often theyhave to go on group outings. It is even more difficult to deal withunscheduledrequestsforcommunityaccessandtovisitfriendsandfamily.We have reduced the assistance in providing transportation for familyvisits,especiallythoseoutoftown.Weoftenstruggletofindenoughstafftotakeconsumerstomedicalappointments.”“Our DSPs are essential to the well being of residents. DSPs providecompanionship; assist with daily activities such as shopping, eating,grooming,minorhealthcare;facilitateextracurricularactivities.Asaresultoflowwagesandinsufficientbenefits,theagencyhasseenaturnoverrateofover25%.TheconstantturnoverofDSPsisverydisruptivetoresidentsas they lose DSPs to whom they have become attached and then mustadjust tonewstaff. This leads toa lowerqualityof life for individualsaswellasmorebehavioralandmoodissues.”“WhenChicagoraisedtheminimumwagetotendollars,ouragencysawitslaborpoolevaporate.ManyapplicantsareunqualifiedfortheDSPpositionandDSPpositionshavetakenoverninetydaystofillwithsomeremainingvacantfor120daysormore.ThedecreaseinDSPsputsourabilitytomeettheneedsofresidentsatrisk.Wehavetodevotemoretimeandmoneytostaff recruitment, using money that should be going to programs forresidents.“
Case: 1:05-cv-04331 Document #: 646 Filed: 01/20/17 Page 18 of 57 PageID #:12249
19
“Person-centered planning has been hardest hit by inadequate Statefunding. Day program rates cannot even cover basic transportation, letalonewhat is needed formore individualized activities. Residential ratesonlyprovideforabareminimumlevelofstaffing,whichdoesnotallowforindividualizedactivities.Wearenotreimbursedfor themoreexperiencedandskilledlevelofstaffpersonneededtocarryoutperson-centeredplans.Ligas Class Members are seeing their integration into the communitycurtailedbecauseof the lackofState fundingandarenotbeingprovidedwiththeservicesset forth intheirTransitionServicePlans. Ouragency isnow facedwith the choice of discharging residents, closing programs, orproviding less than adequate care, all at the expense of individuals withdisabilities.”“MydaughterlivesinanICF/DD(IntermediateCareFacility/DevelopmentalDisabilities) and has an intellectual disability, seizure disorder as well aslimitedcommunicationskills.Withmoredirectcarestaffleavinginrecentyears,thereisaconstantflowofnewstaffwhodonotknowmydaughter.Due tomy daughter’s limited communication skills and complexmedicalneeds,ittakesseveralmonthsforanewstaffmembertogettoknowandunderstandher.Moreimportant,ittakesseveralmonthsformydaughtertofeelcomfortablewiththenewstaffpersonwhomusthelpherwithhermostpersonalneeds.Mydaughterhasacalciumdeficiencyduetoseizuredisorder medications, which makes it critical that her teeth be properlycaredfor. Newstaffdonotknowhowtoproperlycareformydaughter’steethandthepoordentitionhascausedherto loseteethandhascausedtheconditionofherremainingteethtoworsen.Theconstantturnoverofstaff and use of temporary staff has also caused her to suffer increasedanxietyasshedoesnotfeelcomfortablehavinganewpersontakecareofheruntilshebuildsabondwiththatperson.”“My son lives in a CILA and has autism, an anxiety disorder and limitedverbalskills.Routineandpredictabilityareextremelyimportantformyson
Case: 1:05-cv-04331 Document #: 646 Filed: 01/20/17 Page 19 of 57 PageID #:12250
20
and the lack of these results in his becoming very anxious, fearful andfrustrated.Untillastyear,mysonlivedinafour-personCILA,butthentheoperatingagencyhadtoconsolidateandincreasethecapacityof itsCILAsinordertocutcosts.Mysonmovedtoadifferenthouseforsixpeopleanditisanticipatedthatthishousewillbeincreasedtoeightresidentsinorderto further cut costs. Moving to a newhomewithmore residents is veryconfusing tohimand I amconcerned forhis safety and the safetyof theotherresidentsbecauseitismuchmoredifficultforasinglestaffpersontoadequatelysupervisesixoreightindividualswithsignificantdevelopmentaldisabilitiesratherthanfour.Staffworka lotofovertime,resultingintheirfatigue, stress and inability to domore than complete basic tasks. Theydon’thavethetime,energyorexperiencetoprovidethepersonalizedcarethat my son and other residents need. My son loves activities in thecommunity and used to get out into the community at least once eachweek,butnowonlygetsonceortwiceeachmonth.Heisoftenaloneinhisroomandbored,anxiousandfrustrated.Heisbeingseverelylimited.”
EvenmorefarreachingthanindividualorlargegroupcontactswiththeMonitor,
and demonstrating widespread concern with the wages paid to Direct Support
Professionals (DSPs)whoprovidewhat isaptlydescribedas“front lineservices”
tothoselivinginCILAsandICFsinthecommunity,isthefactthatbothchambers
oftheIllinoisLegislaturepassedbillsinthefallof2016toprovide“livablewages”
to such employees. This legislation was vetoed by the Governor and an
attemptedoverrideofthevetowasunsuccessful.
Asnotedabove, this crisis goesbeyond themoney involved in raisingwages to
the impact of the situation on the beneficiaries of the Consent Decree. On
October17,2016, the IllinoisSenateHumanServicesCommitteeheldahearing
Case: 1:05-cv-04331 Document #: 646 Filed: 01/20/17 Page 20 of 57 PageID #:12251
21
onthe“CurrentStatusandFutureofCompliancewiththeLigasConsentDecree
and Related Subject Matter.” The Monitor, Plaintiffs’ Counsel, Intervenors’
Counsel and DHS Chief of Staff were invited to speak, as were a parent, two
serviceprovidersandadirectsupportprofessional.
DHS’ Chief of Staff, Fred Flather, reported on the State’s accomplishments in
meetingorexceedingthebenchmarksrequiredbytheConsentDecreeformoving
ClassMembers into the community. He also described the ongoing process of
defining the “reasonable pace,” as required by the Consent Decree, at which
thosewho choose to live in community-based settingswill be able tomove to
such environments following the six years during which these benchmarks will
have been measured. In addition, at this hearing as well as during Parties’
meetings over the past several months, DHS indicated that the agency is not
opposedtoraisingwagesforDSPsbutthatthisneedstobeaddressedwithinthe
contextofthebudgetprocess.
ScottMendel, Counsel for the Intervenors, spoke about his daughter’s positive
experience living in an ICF/DDanddescribed the Intervenors’ participation as a
partyintheLigascase.Hecitedparagraph4oftheConsentDecreewithregardto
theState’sresponsibilitytobothhonortheresidentialchoices,includingICFs/DD,
of all individuals with developmental disabilities and provide the resources
necessarytomeettheneedsof thosewhochooseto live in ICFs/DD. Henoted
that“LikeCILAs,thereimbursementratesprovidedtoICFs/DDhavenotincreased
since March 2008” and that “in those almost nine years costs have increased
Case: 1:05-cv-04331 Document #: 646 Filed: 01/20/17 Page 21 of 57 PageID #:12252
22
dramatically. As a result, the resources provided by the State are no longer
sufficienttomeettheneedsofICF/DDresidents.Theinsufficientratesarehaving
asevereadverseeffectonICF/DDresidents.Residentsarenotreceivingthecare
they require as a result of low reimbursement rates leading to increased DSP
turnover; reduced physical, occupational and speech therapy; reduced
communityoutings;reducedrecreationalopportunities.This isaviolationofthe
Decree.”
Barry Taylor, Vice President for Civil Rights and Systemic Litigation at Equip for
Equality and lead counsel in Ligas v. Norwood, represented the Plaintiffs and,
following a brief overview of the case and Consent Decree implementation,
stated:“WhiletheStatehassofarmetitsquantitativerequirementsunderthe
ConsentDecree,wedohave serious concerns about thequality of the services
beingprovided.…Fromourperspective,manyofthequalityissuesarisefromthe
lowwagespaid toDisability ServiceProfessionals orDSPs. Themain issues for
ourclientsare:Lackofperson-centeredplanningtoallowourclientstoliveinthe
most integrated setting…; difficulty placing and supporting people in the
community who have significant medical or behavioral needs…; lack of
meaningful participation in the community…; lack of integrated, competitive
employment opportunities as providers are often taking a one-size fits all
approach…because they don’t have sufficient staff to supportmore customized
andintegratedemploymentopportunities.”
Case: 1:05-cv-04331 Document #: 646 Filed: 01/20/17 Page 22 of 57 PageID #:12253
23
The Monitor acknowledged the State’s success in meeting the numeric
benchmarks in theConsentDecreeandhighlighteda fewof thesectionsof the
Fourth Annual Report aswell as the reasons for the finding of noncompliance.
TheMonitor stated therein that “when committedproviders areadmitting that
theiravailablestaffhavetofocusprimarilyonsafety, itcannotbeassumedthat
theentitlementsofthoseprotectedbytheConsentDecreearebeingguaranteed
orthattheexpectationsofthebeneficiariesoftheDecreeandtheirfamiliesare
beingmet.” TheMonitor’s full testimony isnot includedhereinas theexcerpts
presentedabovefromserviceprovidersandfamilymemberseloquentlyexpress
manyoftheMonitors’concernsrelatedtotheinadequatefundingandresulting,
unprecedentedstaffingcrisis.
The service providers spoke in detail about the difficulties in maintaining the
qualityandconsistencyof serviceswhileexperiencing: thehighest staffvacancy
levelsintheirhistoriesandinabilitytorecruitnewstaffduetolowwages;lackof
increase inwages forDSPs in nine years; unprecedented costs of overtime and
staff training; staff unable to address individuals’ needs. In addition, other
written testimony was submitted to this Senate Committee and one of these
documentsprovidedtotheMonitornoted:
“Of issue is that I/DD provider agencies are having an extremelydifficult time hiring and retaining Direct Support Professionals, orDSPs. Specifically,forLigasClassMembers,theinabilitytohireandretainDSPshasmeanttherearefewergrouphomeoptionsforthoseindividualswishingtomoveoutofICFs/DDaswellasalackofDSPstohelpthoseindividualsathomeorinagrouphomereceiveaccessto the community-based supports and services that are required
Case: 1:05-cv-04331 Document #: 646 Filed: 01/20/17 Page 23 of 57 PageID #:12254
24
under the Consent Decree. For the roughly 34,000 DSPs workingacross Illinois, themajor issue is that their average hourly wage is$9.35 or about $19,488.00 per year. This is less than the federalpoverty level fora familyof threewhichhas led tooverhalfof theDSPs utilizing public benefits even though they work full time.Without a living wage, there has been and continues to be highturnoveramongthesecaregivers,whichleadstoinstability.”
All of thismirrors the individual concerns reported to theMonitor by families,
guardiansandserviceproviders,asreportedherein.
The most compelling testimony at the hearing was provided by the DSP who
discussedherongoingfifteenyearsofworkingatajobshelovesbutinthemidst
ofextremelyhighstaffturnoverratesandstaffvacanciesresultingininadequate
staffingandunsafesituations.Shetalkedaboutworkingdoubleshiftsforweeks
ata time, trying tomeet theneedsof six individualsat thesametimewhenall
havehealthandothersignificantneedsrequiringpersonalattention“24/7.”She
nowearnsless,afterfifteenyearsofexemplaryandpersonallyvaluedwork,than
herpreviouswageoftendollarsperhourwhichsheearnedwhenworkingfora
different State department. Her clearly heartfelt narrative about her own
strugglestomeetlivingexpensesandmedicalcostswhilebeingunwillingtogive
uptheworktowhichshe isdevotedwasmore illustrativeofthecrisisthanany
statisticsthatmightbeprovided.
Asisindicatedrepeatedlyaboveinthissectionaswellasinparagraphs4,5and
26 of the Consent Decree, the availability and quality of services are critical to
Case: 1:05-cv-04331 Document #: 646 Filed: 01/20/17 Page 24 of 57 PageID #:12255
25
beneficiaries of the Consent Decree. Paragraph 4 refers to the Defendants’
obligationto“implementsufficientmeasurestoensuretheavailabilityofservices,
supportsandotherresourcesofsufficientquality,scopeandvarietytomeettheir
obligationstosuchindividuals…”Thispointstotheneedforqualitymonitoring
aswellassufficientfunding.
Paragraph5 states that “Annualbudgets submittedbyDefendantsonbehalf of
their agencies shall request sufficient funds necessary to develop andmaintain
services, supports and structures described in the Decree, consistent with the
choicesofIndividualswithDevelopmentalDisabilities,includingClassMembers.”
Thestatementsaboveinthissectionclearlyrefertolackofavailabilityofcertain
chosenopportunitiesandactivitiesforindividuals,aswellasproviders’inabilityto
maintain services and structures due to inadequate wages resulting in staff
shortages.
Paragraph 26 requires that the “Implementation Planmust, at aminimum: (c)
describenecessary resourcedevelopment activities… to implement theDecree”
and (e) identify, based on information known at the time the Implementation
Plan is prepared, any services or supports required in Transition Service Plans
formulated pursuant to the Decree that are not currently available in the
appropriate quantity, quality or geographic location…” This indicates that
resource development efforts are a critical component of the Plan and that
quality as well as quantity of services must be monitored in order to conduct
meaningfulreviewsoftheadequacyofserviceprovision.
Case: 1:05-cv-04331 Document #: 646 Filed: 01/20/17 Page 25 of 57 PageID #:12256
26
FollowingtheMonitor’sreviewofallavailabledocumentsusedbytheBureauof
QualityManagement (BQM) within DDD, theMonitor expressed concerns that
DDDsurveyprotocolshadbeenabbreviatedduring thepast twoyearsand that
theprocessfor followinguponsurveycitationswasnotclear.Therefore,atthe
Monitor’s request, theMonitor, Plaintiffs andDDDmet on a conference call in
early January, 2017 to discuss the current system of monitoring the quality of
services provided in CILAs and day programs. The discussion was informative,
addressedquestions raisedby theMonitorandexplained initiatives thatwillbe
rolledoutthroughtheLifeChoicesprojectwhichareintendedtoimprovetheway
inwhich ISC agencies, CILAs and day services aremonitored. TheMonitorwill
review a sample of surveys previously conducted by the Bureau of Quality
Management,alongwithanyrequiredCorrectiveActionPlansandfollow-ups,to
explore the efficacy of current practices aswell asmake recommendations if it
appears thatanyneededenhancements to the systemarenotbeingaddressed
throughcurrentplanning.
ProblemsrelatedtothemonitoringofCILAsandtheinvestigationofincidentsin
some of these homes were brought to public attention during November and
December, 2016 when the Chicago Tribune published several articles alleging
abuseandneglectoccurringprimarily inCILAsoverthepastthreeorfouryears.
While documenting intolerable treatment of individuals with developmental
disabilitieswholiveinCILAs,thesearticlesalsobroughtforththerolesplayedby
inadequatefunding,insufficientstaffavailabilityandinconsistent,untrainedstaff
in such tragic situations. In addition, it became evident that more effective
Case: 1:05-cv-04331 Document #: 646 Filed: 01/20/17 Page 26 of 57 PageID #:12257
27
oversightonmany levels isanabsolutenecessity.Forexample, theprocessand
outcomesofquality surveys,quarterlynotesby ISCsand investigationsmustbe
furtherevaluated, either aspartof theongoingworkof the LifeChoices teams
and theQuality Committee or as discrete efforts. On a positive note, sessions
hostedbytheQualityCommitteeareinprocessatthetimeofthiswritingandare
planned statewide to train ISCs specifically in person-centered planning and
practices, which is certainly a necessary component of Ligas Transition Service
Plans,IndividualServicePlans,ISCs’notesandalloversightefforts.
On 12/13/2016, the Joint State Senate and House Human Services Committee
held a Subject Matter Hearing to hear testimony regarding abuse and neglect
takingplaceingrouphomesforindividualswithdevelopmentaldisabilities.DHS
Secretary JamesDimasacknowledged that theState takes suchallegations very
seriously anddescribedDHS’ efforts, beginning in2015, “to improvequality for
people.” Hespokeof improvementswithintheOfficeof the InspectorGeneral,
such as increasing the number of investigators, enhancing the supervision of
investigations and discontinuing the participation of providers in their own
investigations. Anassessmentisrequiredofwhetherornotsuchimprovements
arehavingthedesiredoutcomesandwhatadditionalmeasuresarestillneededto
protect those living in CILAs, including Class Members. Secretary Dimas also
outlinedaplantodevelop“reportcards”oftheperformanceofindividualservice
providerstoinformthechoicesoffamiliesandadvocatesinmakingselectionsof
the most appropriate agencies to provide needed services. There was
comprehensive questioning by the legislators and testimony on behalf of Equip
Case: 1:05-cv-04331 Document #: 646 Filed: 01/20/17 Page 27 of 57 PageID #:12258
28
forEquality,TheInstituteonPublicPolicyforPeoplewithDisabilities,TheArcof
Illinois,IARF(IllinoisAssociationofRehabilitationFacilities)andfromthesiblingof
awomanwho lives in aCILA. Someof this testimony, aswell asotherwritten
commentsreceivedthereafter,included:
• “Illinois’ network of community-based services and supports is notoperating under the best of circumstances, with reimbursement rateshavingbeenfrozenbythestatefornearlyadecade.Thesinglemostcriticalissuefacingtheprovisionofcommunity-basedservicesandsupportsistheinabilitytorecruitandretrainfrontlinestaff.Foryears,ourcommunityhasbeensoundingthealarmaboutthisgrowingcrisis.”
• “It isourhopethatthesearticleswillbethecatalyst forthechangesthatneedtobemadeinIllinois.”
• “The widely discussed direct support wage crisis is having a substantialimpactonthequalityofcaredeliveredincommunityresidences.Agenciesare facing unprecedented challenges in recruiting and retaining a directsupport workforce which is the backbone of the community residentialsystem.”
• “Theproblemshighlighted in theTribunearticlearenotan indictmentofcommunity living for people with disabilities. There is powerful andunequivocalsupport forcommunity living ina largebodyofresearchthathas consistently documented positive experiences of people withdevelopmentaldisabilitieslivinginthecommunity.”
• “The fact that anyone is hurt or, worse, dies of anything besides naturalcausesinagrouphomeisunacceptable.Isupportthoroughinvestigation,corrective action and when appropriate, sanctions. We must alsoacknowledgethatindividualswithI/DDareoftenchallenging,andeventhebesttrainedstaffwillneverbeabletopreventallincidentsfromoccurring.
Case: 1:05-cv-04331 Document #: 646 Filed: 01/20/17 Page 28 of 57 PageID #:12259
29
That said, we are not on a level playing field with community housing(CILA). Reimbursement rates are horrendously inadequate…There is noway thatcommunityprovideragenciescancompetewithotherminimumwagejobsthatareeasierandlessstressful. Recruitmentandretentionofqualitystaffisnexttoimpossible,especiallynorthandwestofthecity,andthe ability to do proper training and implement retention strategies andongoingtraining isnotpossiblewiththecurrentreimbursementrates…Tocreate living environments inwhich the health and safety bars are set atthehighestpossiblelevel,weneedtheresourcestodoit.”
One of the provider agencies cited in the first Tribune article had its license
revokedpriortotheJointCommittee’shearing. Thisagencyhadbeensurveyed
orotherwise reviewedbyDDDeight timesbetween5/17/2011and11/14/2016
andtherewererepeatcitationsnotedinallofthesurveysorfollow-upsafterthe
one in 5/2012. Therewere follow-up visits between a few of the surveys and
CorrectiveActionPlanswererequiredatleastthreetimes,includingduringtheir
11/2016survey,lessthanamonthpriortothelicenserevocation.Further,EFE’s
AbuseInvestigationUnit, in2003, issuedaspecialreportentitled“WhyDoesan
Agency That Profited from Exploiting People with Disabilities Remain Taxpayer
Funded?” The subject of this report was the same agency, though using a
differentname,whoselicensewasrecentlyrevoked.Thisreportstatedthatthe
investigation “revealed extremely serious concerns about the services provided
bythisagencytoindividualswithdisabilitiesandthefailureofthisagencytomeet
andmaintainminimumqualityresidentialanddayprogrammingstandards.”The
conclusion stated, in part: “Only through interventions at the highest level of
governmentandthecommitmentofsufficientresourcestosupporttrulyeffective
oversight, monitoring, investigative, and enforcement mechanisms will the
Case: 1:05-cv-04331 Document #: 646 Filed: 01/20/17 Page 29 of 57 PageID #:12260
30
system bywhichwe protect ourmost vulnerable citizens, both old and young,
become anything other than an illusion of safety and humane care.”
Comprehensiverecommendationsarecontainedthereinwhichmightbeusefulto
considerinaddressingcurrentissues.
TheMonitorisnotmakinganygeneralizationsbaseduponhavingreviewedonly
onesuchsituation,butthecurrentsituationinvolvingthisproviderdoesillustrate
that even when an established process for quality monitoring is followed and
thereareuncorrectedcitationsoverseveralyears,itcantaketoolongtoresultin
arevokedlicense.Inordertoclosethisloop,theMonitorrecommendsthatBQM
explorewhetherornottherewasanydocumentationinISCs’quarterlynotesthat
referred to such problems. Upon learning of the revocation of this agency’s
license, theMonitor requested from the Defendants information regarding the
ClassMembersinvolvedandhasaskedforongoingupdates.
Aswasthecase inJanuary,2016andbaseduponallofthematerial included in
thissection,mostsignificantlytheescalatingimpactofthecrisesuponthequality
ofservicesprovidedtothoseprotectedbytheConsentDecree,theMonitoronce
again finds noncompliance with this compliance standard. The Monitor has
informedthePartiesandIntervenorsofthelikelihoodofthisfinding.
It is worthy of note that the Ligas Implementation Team continues to include
eighteenpositionsandthattheonlyvacanciesatthetimeofthecurrentreport’s
Case: 1:05-cv-04331 Document #: 646 Filed: 01/20/17 Page 30 of 57 PageID #:12261
31
preparationisonepositionthatwasvacatedon12/31/2016andisintheprocess
of being filled and another thatwill be filled as of 2/1/2017. Members of this
teamare clearly critical to theMonitor’s day-to-day activities and their insights
andresponsivenesstorequestsaregreatlyappreciated.
There is also some positive news included in the Implementation Plan 2016
Revisions document that describes some of DHS’ new initiatives such as:
increasing the number of Behavior Therapy hours an individual may receive
annually under theWaiver; engaging a consultant through a State Mentoring
GrantwiththeFederalDepartmentofLabortoexploreopportunitiestoenhance
access to employment services; developing a web-based reporting and search
mechanism for tracking vacancies in residential and day programs as well as
providers’willingnesstodevelopnewservicecapacity.
Case: 1:05-cv-04331 Document #: 646 Filed: 01/20/17 Page 31 of 57 PageID #:12262
32
II. ClassMemberLists
Paragraphs8and9oftheConsentdecreerequirethattheDefendantsmaintaina
statewidedatabaseinwhichallClassMembersareenrolledandwhich,alongwith
waiting list data, is promptly revised. The Implementation Plan is required to
includeinformationregardingtheadequacyofthePUNS(PrioritizationofUrgency
ofNeedsforServices)database.
Paragraph2oftheConsentDecreerequiresa listofClassMemberswhoqualify
forMedicaidWaiverservices, live inan ICF/DDwithnineormoreresidentsand
have affirmatively requested community-based services or placement in a
community-basedsetting.AnotherlistisrequiredofClassmemberswhoqualify
forMedicaidWaiverservices, live inafamilyhomeandare inneedofandhave
affirmatively requested home and community-based services or services in a
community-basedsetting. The individualson this listareknownasWaitingList
ClassMembersandthislistisconsideredasubsetofthePUNSlist.
AsindicatedintheFourthAnnualReport,theDDDhadatthattimeestablishedan
automatedprocesstoaddnewClassMemberstothePUNSlistaswellasremove
thosewhoarenolongereligible.Inaddition,asreflectedintheImplementation
Plan 2016 Revisions, DDD conducted, between 5/1/15 and 6/30/16, a special
initiative “to ensure information and data on individuals enrolled is accurate,
complete and current.” This PUNS Integrity Project involved providing targeted
fundstotheISCagencies“toworkwithindividualsandfamiliestobringrecords
Case: 1:05-cv-04331 Document #: 646 Filed: 01/20/17 Page 32 of 57 PageID #:12263
33
up to date.” It is reported that as of 9/1/2016 96.8% of the PUNS records
statewidewere currentwithin one year and this exceeded the 95%benchmark
thathadbeenestablishedfortheendofthisinitiative.
Prior to the completion of the PUNS Integrity Project, the Parties had begun
discussing the need for a more efficient way to track the progression of Class
Memberswhoareseekingservicestothepointofinitiationofwaiverservices.A
new comprehensive list was developed, with input from the Plaintiffs and the
Monitorandthefirstsuchlistwasdisseminatedon7/29/2016.Attherequestof
theMonitor,DDDpromptlyprovidedanunscheduledupdateon1/13/2017.This
newlistservedasthebasisforadiscussionregardingfurtherclarificationofboth
the information included and how ClassMembers move off the list as well as
movebackon if necessary. TheMonitor’s reviewof this updated list indicated
442 class members to be actively seeking services. In addition, this update
provides information as to how long classmembers have remained on the list
followingselectionfromthePUNSwaitinglist.
LigasClassMembersSeekingServices(1/13/17)N=442
PUNSSelectionDate #ofClassMembersSeekingServices2012 402013 62014 472016 248
ResidinginICF/DD 101
IntheFourthAnnualReporttheMonitorhadnoteddelaysininitiationofwaiver
services for class members following selection from the PUNS waiting list.
Discussions are ongoing regarding the content of the new list to provide
Case: 1:05-cv-04331 Document #: 646 Filed: 01/20/17 Page 33 of 57 PageID #:12264
34
additional details regarding classmembers’ progression toward placement. The
efforts of those involved in this process are integral to theMonitor’s ability to
identify potential barriers to achieving transitions and to determine Class
Members’statustowardreceivingdesiredservices.
Case: 1:05-cv-04331 Document #: 646 Filed: 01/20/17 Page 34 of 57 PageID #:12265
35
III. TransitionServicePlans
Beginning inFebruary2016andcontinuing intoFY2017,theMonitorselecteda
sampleof the transitionplanscompletedsince January2015,atwhich timethe
mostrecentversionoftheplanswasconsistentlyinuse.TheMonitor’sDataand
Program Analyst, Melanie Reeves Miller, assisted in reviewing and evaluating
these plans to determinewhether further revisions or training are needed and
whethertheplansarefacilitatingprovisionofappropriateservicesandsupports
chosenby the classmembers, families or guardianswithwhom theplanswere
developed.
TheMonitor,alongwithMs.Miller, reviewedtransitionplansandserviceplans
forfifty-three(53)classmemberswithafocusonassessingtheadequacyofLTSPs
as well as whether the class member’s preferences and service/support needs
were reflected in the initial service plan. It was noted that there had been
improvementinthequalityofLTSPsoverthepastyear.TheMonitorfoundthat
serviceplansreflectedtheclassmember’stransitionplanandforthemostpart,
transitionsoccurredinatimelymanner.
Inmanyinstances,theserviceplanprovidedtotheMonitorwasaninitial30-day
staffing and therefore did not reflect whether services/supports were fully
implemented. TheMonitor then requested fromDDDadditional documents to
include themost recent Individual Support Plan and themost recent Individual
ServiceandSupportAdvocacy(ISSA)VisitingNotecompletedbytheIndependent
Case: 1:05-cv-04331 Document #: 646 Filed: 01/20/17 Page 35 of 57 PageID #:12266
36
ServiceCoordinator(ISC).ForthoseclassmemberswhohadanewISPdeveloped
sincetransition,thatISPwasprovidedtotheMonitorasdocumentationofoneof
therequiredfourISCvisitsperyearfor31classmembers(58%)andISCvisitnotes
wereprovidedfor35classmembers(67%).Forsomeclassmembers,bothtypes
ofdocumentswereprovided.
As set forth in the ISSA Guidelines issued by DHS, Independent Service
Coordinators are expected to conduct a minimum of four visits per year: one
annualvisit forparticipation in thedevelopmentof theclassmember’s ISP;one
annualvisit toassist theclassmember incompleting theConsumerSatisfaction
Survey;oneannualvisittotheclassmember’sdayprogramsite;andoneannual
visit to the classmember’s residence. As indicated in the Guidelines, “Besides
participating inthedevelopmentof theannualserviceplan, ISCswill reviewthe
service plan for adequacy in meeting the needs and preferences of the
individual...The priority goal is that issues of health, safety, and meaningful
programmingarereceivingattention.”BasedonreviewoftheISCvisitnotes,the
Monitordeterminedthatonly14(40%)ofthe35visitnotesprovidedcontaineda
substantive description of whether, per the Guidelines, “the ISP contains
identified outcomes for the person that substantially meet all of the person’s
needs; services arebeingprovided in accordwith the ISP; andprogress toward
outcomes is evident (or if not evident, the team is revising the ISP in order to
promoteprogresstowardoutcomes).” Forexample,manyvisitnotescontained
generalstatementswithoutreferencetospecificoutcomes,suchas:
Case: 1:05-cv-04331 Document #: 646 Filed: 01/20/17 Page 36 of 57 PageID #:12267
37
• “Goals are reviewed monthly and revisions are made as necessary. Inaddition, the ISP team meets annually to discuss goal performance andrecommendationsaremadebasedongoalperformance.”
• “[Class Member] is making some progress on objectives. Data wassomewhatlimited,however[ClassMember]reportedworkingonmanyofthem and continues to need towork on possiblemedication side effectsandfollowingabudget.”
• “[ClassMember] has amonthly progress note in his file for eachmonth.His goals are updated every three months. His plan is being revised asneeded.”
On a positive note, in at least one case, the visit note reflected “monthly
summaries were not provided so progress could not be assessed. Data for
SeptemberandOctoberwascollectedduringthevisitbythefacilitator.Shemet
her objectives for both of thesemonths.” The ISC flagged the lack ofmonthly
summaries as a need for follow-up action. For another individual, visit note
indicatedthatprovideragencyQualifiedIntellectualDisabilityProfessional(QIDP)
monthly notes were missing for February 2016 through April 2016. The ISC
flaggedthisforfollow-up.
Asnotedabove,thisprojectwas initiatedtoevaluatetheadequacyofLTSPs, to
determine whether or not they serve as foundations upon which individual
serviceplansaredeveloped, andassesswhether servicesarebeingprovidedas
describedintheISPandwhetherprogresstowardoutcomesisevident.Inorder
toreviewimplementationofserviceplans,theMonitorrequestedISCvisitnotes
foreachperson inthesampletodeterminewhetherthesemonthlynotesserve
Case: 1:05-cv-04331 Document #: 646 Filed: 01/20/17 Page 37 of 57 PageID #:12268
38
as a measure of achievement of outcomes identified in class members’ ISPs.
Overall, the Monitor found that while visit forms expect the ISC to indicate
whether progress is being made towards outcomes, there was absence of an
analysisoracomparisonofprogresstothepreviousquarter(s)onwhichtobase
thedeterminationof progress or lack thereof. Therefore, basedon the finding
thatonly40%ofthevisitnotescontainedthenecessaryinformationonwhichto
measure implementation and progress toward personal outcomes, it is
recommended that emphasis be placed on addressing this issue as part of
ongoinginitiativestoenhancequalitymonitoringasdescribedinsectionIabove.
Case: 1:05-cv-04331 Document #: 646 Filed: 01/20/17 Page 38 of 57 PageID #:12269
39
IV. TransitionforClassMembersinICFs/DD
Paragraph 17 of the Consent Decree requires that within six years after the
approvalof theDecree,allClassMembers residing in ICFs/DDasof thedateof
theapprovaloftheDecreewilltransitiontoCommunity-Basedsettingsconsistent
with their Transition Service Plans if, at the time of the transition, the Class
Member requests placement in a Community-Based setting as confirmed and
documentedinaccordancewiththeDecree.
Itisrequiredthatone-thirdoftheClassMembersinthiscategorytransitiontothe
communityby12/15/2013,two-thirdsby12/15/2015andallby6/15/2017.The
actual target numbers are fluid, based upon the list defining this category. To
date, the Defendants have consistently exceeded the target numbers with
placements totalingmore than 300 beyond the target for 12/1/2015, bywhich
time1255of 1446 then active Ligas ICF/DDClassMembers had transitioned to
the community. As of 12/31/2016, 1363 of 1481 active Ligas ICF/DD Class
Members had transitioned to the community. Of these 1363 Class Members,
1332went toCILAsand theMonitorhas requestedadditionaldetails related to
thetransitions.
TheMonitorapplaudstheeffortsinvolvedinexceedingthebenchmarksandwill
continuetoworkwiththePlaintiffsandDefendantstofacilitatethetransitionsof
Ligas ICF/DDClassMemberswho choose tomove to the community. All Class
Case: 1:05-cv-04331 Document #: 646 Filed: 01/20/17 Page 39 of 57 PageID #:12270
40
Membersmustbeofferedavarietyofoptionsandopportunitiesinordertomake
informed decisions about where, how and with whom they choose to receive
servicesandsupports.TheMonitorwillcontinuetoworkcloselywiththeParties
in tracking how such choices are facilitated, particularly in consideration of the
obstacles,asdiscussedinsectionI.ResourcesandCapacityherein,relatedtoboth
themaintenanceofexistingcommunityservicesandfurtherdevelopment.
Case: 1:05-cv-04331 Document #: 646 Filed: 01/20/17 Page 40 of 57 PageID #:12271
41
V. CrisisServices
As indicated in ¶21(a)-(b) of the Ligas Consent Decree, “an individual is in a
situation of “Crisis” if he or she is at imminent risk of abuse, neglect, or
homelessness. The provision of interim emergency services (including interim
placement inan ICF-DDwherenoplacement inaCommunity-BasedSettingwas
immediately available) will not necessarily exclude the Individual from being
deemedtobeinasituationofCrisis.If,followingascreening,theIndividualwho
isdetermined tobe inCrisis requestsappropriateCommunity-BasedServices to
be provided in the Family Home or requests placement in a Community-Based
Setting,Defendantswillpromptlydevelop,inconjunctionwiththeClassMember,
aTransitionServicePlan.”
State Defendants are required to serve expeditiously classmemberswhomeet
theabove-describedcriteriaandwhorequestcommunity servicesorplacement
in a community-based setting. A review of crisis requests from July 1, 2015
through June30,2016 indicated that506 crisis services requestswere received
and reviewed by DDD with 482 requests approved. Denials of crisis services
requestswereduetocrisiscriterianotbeingmetand/ordeterminationoflackof
clinicaleligibility.Accordingtothecrisisdata,between7/1/15and6/30/16,one
hundred seventeen (117) crisis requests receivedwere classified as abuse, 240
wereclassifiedasneglect,and125wereduetotheindividualbeinghomeless.
Case: 1:05-cv-04331 Document #: 646 Filed: 01/20/17 Page 41 of 57 PageID #:12272
42
117
240
125
ClassificaWonofApprovedCrisisRequestsJuly1,2015-June30,2016
Abuse
Neglect
Homeless
100
245
116
ClassificaWonofApprovedCrisisRequestsJuly1,2014-June30,2015
Abuse
Neglect
Homeless
71
233
93
ClassificaWonofApprovedCrisisRequestsJuly1,2013-June30,2014
Abuse
Neglect
Homeless
Case: 1:05-cv-04331 Document #: 646 Filed: 01/20/17 Page 42 of 57 PageID #:12273
43
Services provided to class members in crisis included four types of CILA
(Community Integrated LivingArrangement) options: 24-Hour CILA,Host Family
CILA, Intermittent CILA, and Family CILA, in addition to Home-Based Support
Services (HBS). Of the 482 crisis requests approved, 261 were approved to
receive 24-Hour CILA, 9 were approved to receive Host Family CILA, 19 were
approved to receive IntermittentCILA, and23wereapproved to receiveFamily
CILA.Home-BasedSupportServiceswereapprovedfor170classmembers:
261
9 19
23
170
ServicesAuthorizedJuly1,2015-June30,2016
24-HourCILA
HostFamilyCILA
IntermirentCILA
FamilyCILA
Home-BasedServices
244
31917
178
ServicesAuthorizedJuly1,2014-June30,2015
24-HourCILA
HostFamilyCILA
IntermirentCILA
FamilyCILA
Home-BasedServices
Case: 1:05-cv-04331 Document #: 646 Filed: 01/20/17 Page 43 of 57 PageID #:12274
44
Combining the three reporting years (7/1/13-6/30/16), a total of 1340 crisis
requestsoutof1415requestsreceivedhavebeenapprovedbyDDD.
Forthissamereportingperiod(7/1/13-6/30/16),serviceswereprovidedtoclass
members in crisis within four types of CILA (Community Integrated Living
Arrangement)options:
177
7
20
13
180
ServicesAuthorizedJuly1,2013-June30,2014
24-HourCILA
HostFamilyCILA
IntermirentCILA
FamilyCILA
Home-BasedServices
288
718
334
ClassificaWonofApprovedCrisisRequestsJuly1,2013-June30,2016
Abuse
Neglect
Homeless
Case: 1:05-cv-04331 Document #: 646 Filed: 01/20/17 Page 44 of 57 PageID #:12275
45
During the 2013/2014 reporting period, the Monitor established, with the
agreement of the parties, that the timeframe to receive services for class
members in crisis will be 24-72 hours, although this timeframe may vary,
depending on individual circumstances, or if temporary services are in place to
addresstheimmediatecrisis.Forthepastthreeyears,theMonitorhasanalyzed
classmemberinformationanddatafromallcrisisrequestsreceivedandreviewed
bytheDefendantsanddeterminedtomeettherequirements forcrisisservices.
FromtheMonitor’sanalysis,improvementwasnotedinthetimelyreviewofthe
crisispacketsuponreceiptbytheDefendants.
After crisis status was confirmed, 40% (545) of the Class Members who were
found to be in crisis received some service within a 24-72 hour period. The
following two charts represent theMonitor’s analysis with a view of the three
yearsincomparisonandthethreeyearsinsummary.
421
10
3930
358
ServicesAuthorizedJuly1,2013-June30,2016
24-HourCILA
HostFamilyCILA
IntermittentCILA
FamilyCILA
Home-BasedServices
Case: 1:05-cv-04331 Document #: 646 Filed: 01/20/17 Page 45 of 57 PageID #:12276
46
TimelinessofAuthorizationofCrisisServices
FY2013-2014 FY2014-2015 FY2015-2016 Overall2013-2016N=397 N=461 N=482 N=1,340
24-72hours 107 27% 218 47% 220 46% 545 40%4-9days 122 31% 151 33% 175 36% 448 33%10-19days 74 19% 64 14% 60 12% 198 15%20-29days 36 9% 15 3% 15 3% 66 5%30-39days 15 4% 6 1% 3 1% 24 3%40+ 35 8% 5 1% 6 1% 46 3%InsufficientData 8 2% 2 1% 3 1% 13 1%
Aspresentedabove,datafromthemostrecentreportingperiod(July1,2015to
June30, 2016) shows that46%of the classmemberswhowere found tobe in
crisis, received some servicewithin a 24-72 hour period after their crisis status
was confirmed; for (36%) services were initiated between 4 and 9 days; 12%
receivedservicesbetween10-19days;3%receivedservicesbetween20and29
days; serviceswere not initiated for 2% of the classmembers formore than a
month; and for three class members, data was insufficient to include in the
40%
33%
15%
5%
3% 3% 1%
TimelinessofAuthorizaWonofCrisisServices7/1/13-6/30/16
≤3days
4-9days
10-19days
20-29days
30-39days
40+days
UnableToDetermine
Case: 1:05-cv-04331 Document #: 646 Filed: 01/20/17 Page 46 of 57 PageID #:12277
47
analysis. WhilethepasttwoyearsshowimprovementoverFY13/14,thereare
stillfewerthanone-halfoftheindividualswhowerefoundtobeincrisisreceiving
some services within the 24-72 hours agreed upon timeline. The Monitor
recommends that the Parties address this situation at an upcoming Parties’
meeting.
Review of the data associated with the 1,340 crisis requests received and
reviewed between July 1, 2013 and June 30, 2016 revealed that, in nearly all
cases,a“safetyplan”hadbeendeterminedtobeinplacefortheclassmemberin
ordertoensuresafetyandreductionofriskwhileawaitingapprovalofservices.
IntheFourthAnnualReport,itisnotedthattheMonitorraisedconcernsastothe
adequacyofsafetyplanswhereintheclassmemberincrisisisnotinapermanent
or stable situation (e.g., jail, psychiatric hospital, nursing home). It was
recommended that the Defendants and Monitor confer to clarify criteria for
determining adequacy of a safety plan. Discussions have taken place during
Parties’Meetingsandonotheroccasionsthroughoutthepastyearduringwhich
DDDreportedthatthisissueisbeingaddressedandprogresswillbereportedat
upcomingParties’meetings.
The Fourth Annual Report reflects an analysis of crisis data to determine the
relationshipbetweencrisisapplicantsandthePUNSlist.Asnotedinthatreport,
some individuals incrisis situationswerenotselected forservicesbecause their
PUNSenrollmentwasout of date and/or didnot reflect current circumstances.
Alsoincludedtherein,thePUNSIntegrityProjecthadbeenimplementedtobring
Case: 1:05-cv-04331 Document #: 646 Filed: 01/20/17 Page 47 of 57 PageID #:12278
48
and maintain PUNS enrollments current. That project has been concluded
successfully.
AsnotedintheLigasImplementationPlan2016Revisions(filedonNovember16,
2016),inadditiontoraisingthequestionoftheadequacyofcrisissafetyplansin
the Fourth Annual Report, theMonitor also expressed concern that nearly half
(49%) of the individuals with approved crisis placements were on the PUNS
waiting list for three yearsormore. Per theMonitor’s recommendation in the
FourthAnnualReport,DHSbeganduring2016todiscusscriteriafordetermining
adequacy of a safety plan and considering the relationship between the PUNS
waitingtimeandcrisisrequests.ConversationsamongthePartieswillbeinitiated
duringthesecondhalfoffiscalyear2017.Thechartbelowreflectsthelengthof
time of PUNS enrollment prior to receipt of the crisis request for fiscal year
2015/16.
FY15andFY16ApprovedCrisisPlacementsandLengthoftimeonPUNSWaitingList
TimePeriod NumberofPlacements %ofTotalOneMonthorLess 69 7%Over1Monthto1Year 212 22%1to2Years 107 11%2to3Years 82 9%3to4Years 57 6%4YearsorMore 326 34%NoDataReport 98 10%
N=951
Aspresentedinthechartabove,40%ofindividualswithapprovedcrisisservices
were on the PUNS waiting list for 3 years or more. This demonstrates a 9%
improvementoverthepreviousyear.
Case: 1:05-cv-04331 Document #: 646 Filed: 01/20/17 Page 48 of 57 PageID #:12279
49
The Monitor greatly appreciates the assistance of Melanie Reeves Miller, the
Monitor’sDataandProgramAnalyst,inconductingthisreviewofCrisisServices.
Case: 1:05-cv-04331 Document #: 646 Filed: 01/20/17 Page 49 of 57 PageID #:12280
50
VI. TransitionforClassMembersonWaitingList
TheConsentDecreerequiresthatClassMembersdescribedin¶22oftheDecree
will transition to the community and be referred to as Waiting List Class
Members. A specific schedule for such transitions to community services or
community-basedsettingsisdelineatedin¶22whichrequiresthefollowing:
Ø 1000byJune15,2013
Ø Additional500byJune15,2014
Ø Additional500byJune15,2015
Ø Additional500byJune15,2016
Ø Additional500byJune15,2017
The ImplementationPlan incorporatescriteria for theprioritizationofselections
ofWaitingListClassMembersandwithineachprioritizedcategoryselectionsare
tobemadeaccording to the lengthof time theClassMemberhasbeenon the
PUNSlist.
¶23 of the Consent Decree requires that following June 15, 2017,Waiting List
Class Members “shall receive appropriate Community-Based Services and/or
placementinaCommunity-BasedSettingsuchthattheymoveofftheWaitingList
at a reasonablepace.” During thepast year, thePlaintiffs,Defendants and the
Monitorhaveinitiatedtheprocesstodefinethis“reasonablepace.”Discussions
areongoinginorderforimplementationtobeginbytherequireddate.
Case: 1:05-cv-04331 Document #: 646 Filed: 01/20/17 Page 50 of 57 PageID #:12281
51
VII. Outreach
Paragraph 25 of the Consent Decree requires that Defendants “maintain a fair
and accessible process by which individuals with developmental disabilities or
their legal guardians canaffirmatively request inwriting to receiveCommunity-
BasedServicesand/orplacementinaCommunity-BasedSettingortoreceiveICF-
MR services in an ICF-DD, and Defendants shallmaintain up-to-date records of
thoserequests.”
The Defendant’s outreach efforts are defined comprehensively in the
Implementation Plan 2016 Revisions and are divided into a “Community
Outreach”sectionandasectiontitled“OutreachtoPersonsinICFs/DD.”Inorder
to address the issue of identifying Potential ClassMembers residing in ICFs/DD
(excludingthoselivinginICFs/DDwhohadalreadysubmittedwrittenrequeststo
beexcludedfromtheClass), theDefendantssecuredtheservicesoftheCouncil
on Quality Leadership (CQL) and the completion of that project resulted in a
reportthatwassharedwiththeMonitorandPartiesinApril,2016.Inthatreport,
CQL identified 123 individuals who chose to become ClassMembers and were
addedtoClassMembersList.Inaddition,55individualswhohadrequestedextra
timetoconsidertheiroptionsweregiveninformationregardingtheappropriate
ISCagenciestocontactifdesiredifthefuture.UponrequestoftheMonitor,DDD
staffagreedtocontact the55 individualsnotedaboveandtoprovide follow-up
informationregardingthe123individualswhowereaddedtotheClasslist.
Case: 1:05-cv-04331 Document #: 646 Filed: 01/20/17 Page 51 of 57 PageID #:12282
52
It is important to note that in order to become amember of theWaiting List
Class, people need tomake a recordwith the State confirming their desire for
communityservices.PeoplewhoarealreadyonthePUNSlistaredeemedtohave
madesucharecordandarepartoftheClass.
Case: 1:05-cv-04331 Document #: 646 Filed: 01/20/17 Page 52 of 57 PageID #:12283
53
VIII. ImplementationPlan
¶26of theConsentDecreerequiresthat“theDefendants,withthe inputof the
Monitor, Plaintiffs, Class Counsel, Intervenors and Intervenors’ Counsel shall
createandimplementanImplementationPlantoaccomplishtheobligationsset
forth intheDecree,”and¶28requiresthatthisplanbe“updatedandamended
annually, or at such earlier intervals as Defendants deem necessary or
appropriate.”
AteachscheduledParties’meeting,theDefendantsprovideverbalupdatesofthe
Plan’s activities, as requested by the Parties, Intervenors and Monitor, and
discussionsarefocusedupontheareasdeemedmostsignificantatagiventime.
The Implementation Plan updates and proposed revisions are provided by the
Defendants to the Plaintiffs, Intervenors and Monitor for Consideration. Each
year, through 2015, negotiations have taken place and resulted in jointly
developed revisions being agreed upon before being submitted to the Court.
Howeverin2016,despitesignificanteffortsbyallinvolved,thePartiescouldnot
reach agreement as to some of the Plan’s content. As referred to in section I
(ResourcesandCapacity)herein,theConsentDecreerequiresat¶26thatalistof
items that must be included in the Implementation Plan. Two of the required
itemsare:
Case: 1:05-cv-04331 Document #: 646 Filed: 01/20/17 Page 53 of 57 PageID #:12284
54
(c) describenecessaryresourcedevelopmentactivities…toimplementthe
Decree;
(e) identify,basedoninformationknownatthetimetheImplementation
Plan is prepared, any services or supports required in Transition Service Plans
formulated pursuant to the Decree that are not currently available in the
appropriatequantity,qualityorgeographiclocation;
TheMonitordidnotrecalltherequirementof¶26(c)untilpreparingthecurrent
reportandthereforedidnotbring it to theParties’attention. This isnotbeing
citedasnoncompliancewiththeDecree.Rather,itisillustrativeofwhytherewas
no joint submission to the Court of the 2016 Revisions. The Plaintiffs and
Intervenors agreed to disagree with the Defendants on the topic of including
informationthereinregardingnecessary“resourcedevelopmentactivities.”
Regarding ¶26(e), the Monitor has initiated discussions related to Quality
Monitoring and, while Defendants have agreed to participate in such
conversations, there has been some disagreement as to whether the Consent
Decreeincludesanyrequirementsrelatedtothisarea.Inordertoidentifyalack
ofservicesavailableoftheappropriatequality,therewouldneedtobearobust
systemtomeasurethequalityofexistingservices.Thismatterisalsodiscussedin
theabovesectionI.
Case: 1:05-cv-04331 Document #: 646 Filed: 01/20/17 Page 54 of 57 PageID #:12285
55
Whetherornot issuesare included inthe ImplementationPlanoragreedupon,
the Monitor appreciates the cooperation of the Parties and Intervenors in
thoroughlyaddressingissuesuponwhichimplementationoftheConsentDecree
depends.
Case: 1:05-cv-04331 Document #: 646 Filed: 01/20/17 Page 55 of 57 PageID #:12286
56
IX. DataReports
Paragraph33oftheConsentDecreerequiresthattheDefendants,not lessthan
every sixmonths, “provide to theMonitor, Plaintiffs, ClassCounsel, Intervenors
andIntervenors’Counselandmakepubliclyavailable,adetailedreportcontaining
data and information sufficient to evaluate Defendants’ compliance with the
DecreeandDefendants’progresstowardachievingcompliance.”
TheMonitoracknowledgesthattheLigasDataReportsaresubmittedtimelyand
thatinterimdatarequestedbytheMonitorisalsoprovidedpromptly.DDDstaff
are consistently available to answer the Monitor’s questions, clarify data and
addressconcernsrelatedtodocumentstheyhaveprepared.
Case: 1:05-cv-04331 Document #: 646 Filed: 01/20/17 Page 56 of 57 PageID #:12287
57
CLOSINGCOMMENTS
TheMonitor remains indebted to her predecessor, Tony Records, whoworked
withthePartiestocreatethesystemsforensuringcompliancewiththeConsent
Decree and shared with the current Monitor his expertise and experience.
Gratitude isalsoexpressed to theParties, families,ClassMembers, Intervenors,
advocates, providers of services, colleagues and others who have shared their
insights, intelligenceand inspiration. TheMonitor looks forward toengaging in
continuedsharedeffortstoassurethatallofthosewhobenefitfromtheConsent
Decreeachievetheirchosengoals.
RespectfullySubmitted: RonnieCohn CourtMonitor [email protected]
Case: 1:05-cv-04331 Document #: 646 Filed: 01/20/17 Page 57 of 57 PageID #:12288