RSA-509 for FY-2016: Submission #73

State name Michigan

Report through date 9/30/2016

General Information

Designated Agency Identification

Name Michigan Protection and Advocacy Service Inc.

Address 4095 Legacy Parkway

Address 2 Suite 500

City Lansing

State {Empty}

Zip Code 48911

E-mail Address ecerano@mpas.org

Website Address http://www.mpas.org

Phone (517) 487-1755

TTY Phone (517) 374-4687

Toll-free Phone (800) 288-5923

Toll-free TTY Phone {Empty}

Fax (517) 487-0827

Name of P&A Executive Director Elmer L. Cerano

Name of PAIR Director/Coordinator Mark A. Cody

Person to contact regarding report Mark A. Cody

Contact Person phone (517) 487-1755

Contact Person phone ext 628

Part I. Non-Case Services

A. Individual Information and Referral Services (I&R)

1. Individuals receiving I&R within PAIR priority areas 320

2. Individuals receiving I&R outside PAIR priority areas 1559

3. Total individuals receiving I&R (lines A1 + A2) 1879

B. Training Activities

1. Number of trainings presented by PAIR staff 4

2. Number of individuals who attended training (approximate) 119

Training Training - Access & Disability Issues - Flint - 4/19/2016 63Training - Allegiance Health Forensic Nursing (SANE) Training - Jackson - 1/20/2016 23Training - Forensic Nursing (SANE) Conference - 11/18/2015 19Training - Oakland University Nursing Program - 11/10/2015 14

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C. Information Disseminated to the Public

1. Radio and TV appearances by PAIR staff 4

2. Newspaper/magazine/journal articles 0

3. PSAs/videos aired 0

4. Hits on the PAIR/P&A website 39495

5. Publications/booklets/brochures disseminated 1410

6. Other (specify separately) 0

Narrative 6. Other (specify separately)Other activities funded by PAIR, as well as other MPAS funding sources, include:In addition, MPAS has 1,635 Facebook likes, including 263 new likes this fiscal year.MPAS also provided advance directive information upon request to 194 individuals.

Part II. Individuals Served

A. Individuals Served

1. Individuals still served as of October 1 (carryover from prior FY) 25

2. Additional individuals served during the year 20

3. Total individuals served (lines A1 + A2) 45

4. Individuals w. more than 1 case opened/closed during the FY. (Do not add this number to total on line A3 above.) 1

B. Individuals served as of September 30

Carryover to next FY may not exceed total on line II. A.3 above 20

C. Problem Areas/Complaints of Individuals Served

1. Architectural accessibility 2

2. Employment 2

3. Program access 2

4. Housing 3

5. Government benefits/services 0

6. Transportation 0

7. Education 0

8. Assistive technology 2

9. Voting 0

10. Health care 5

11. Insurance 0

12. Non-government services 1

13. Privacy rights 0

14. Access to records 0

15. Abuse 4

16. Neglect 24

17. Other 0

D. Reasons for Closing Individual Case Files

1. Issues resolved partially or completely in individual favor 13

2. Other representation found 0

3. Individual withdrew complaint 1

4. Appeals unsuccessful 5

5. PAIR Services not needed due to individual's death, relocation etc 1

6. PAIR withdrew from case 1

7. PAIR unable to take case because of lack of resources 0

8. Individual case lacks legal merit 2

9. Other 3

Please explain These service requests were initially opened as PAIR eligible, but closed and reopened to a different funding source upon receipt of additional information.

E. Intervention Strategies Used in Serving Individuals

1. Technical assistance in self-advocacy 0

2. Short-term assistance 2

3. Investigation/monitoring 13

4. Negotiation 1

5. Mediation/alternative dispute resolution 0

6. Administrative hearings 0

7. Litigation 10

8. Systemic/policy activities 0

Part III. Statistical Information on Individuals Served

A. Age of Individuals Served as of October 1

1. 0 - 4 0

2. 5 - 22 0

3. 23 - 59 12

4. 60 - 64 6

5. 65 and over 27

B. Gender of Individuals Served

1. Females 21

2. Males 24

C. Race/Ethnicity of Individuals Served

1. Hispanic/Latino of any race 0

2. American Indian or Alaskan Native 0

3. Asian 1

4. Black or African American 15

5. Native Hawaiian or Other Pacific Islander 0

6. White 29

7. Two or more races 0

8. Race/ethnicity unknown 0

D. Living Arrangements of Individuals Served

1. Independent 9

2. Parental or other family home 0

3. Community residential home 2

4. Foster care 0

5. Nursing home 31

6. Public institutional living arrangement 1

7. Private institutional living arrangement 0

8. Jail/prison/detention center 2

9. Homeless 0

10. Other living arrangements 0

11. Living arrangements not known 0

E. Primary Disability of Individuals Served

2. Deaf/hard of hearing 2

4. Orthopedic impairment 7

5. Mental illness 1

6. Substance abuse 0

7. Mental retardation 0

8. Learning disability 1

9. Neurological impairment 20

10. Respiratory impairment 5

11. Heart/other circulatory impairment 5

12. Muscular/skeletal impairment 0

13. Speech impairment 0

14. AIDS/HIV 2

15. Traumatic brain injury 0

16. Other disability 0

Part IV. Systemic Activities and Litigation

A. Systemic Activities

1. Number of policies/practices changed as a result of non-litigation systemic activities 2

2. Number of individuals potentially impacted by policy changes 39447

Describe your systemic activities. According to the Kaiser Family Foundation, at the end of Fiscal Year 2014, there were 39,447 residents in Michigan's 434 certified nursing facilities. Each one of these residents is a beneficiary of the work of MPAS.1. Statewide Nursing Home Investigations:Statewide Nursing Home Investigations: Funded in part by PAIR, as well as other P&A funding, MPAS has assigned specific staff to review reports of the licensing and survey agency of the State of Michigan. If, upon review, it appears there is probable cause to believe a resident has been subjected to abuse and/or neglect, MPAS obtains relevant records, by either using our access authority or with the consent of the resident or his/her authorized representative.In addition to the records provided by the facility, MPAS staff also obtain records from other sources. These could include the county medical examiner, law enforcement, hospitals, etc. These records are reviewed and, if MPAS believes abuse/neglect has occurred, a complaint is filed with state agencies such as the Bureau of Professional Licensing and the Bureau of Community and Health Systems. Once a complaint is filed, MPAS staff track the complaint to determine whether the state agency has found that abuse/neglect has occurred and, if so, whether appropriate disciplinary action has been ordered. Typically, if there are sanctions, they are imposed on the nursing facility staff. These sanctions can include the imposition fines, mandatory continuing education, probation and a temporary or permanent ban on working in a nursing facility.In total, in FY 2016, 195 surveys were reviewed. Eleven service requests were opened and 30 projects were opened for investigation.Interestingly, the average number of deficiencies cited by Michigan nursing facility state survey teams decreased from 11.9 per facility in calendar year 2011 to 9.7 per facility in 2014. However, the rate of which complaints are received by MPAS has remained steady, forcing us to re-evaluate our strategies for FY17.As an example of the impact of this project, an 80 year old woman in a nursing facility was injured and ultimately died due to those injuries when her staff failed to follow her care plan. The care plan detailed the proper use of a mechanical lift. The aide was found to have neglected the woman and the aide is no longer allowed to work in facilities that accept Medicare or Medicaid.In FY2016, to obtain records needed for nursing facility investigations, MPAS lawyers filed suit against four nursing facilities and one hospital. These suits were filed only after MPAS clearly put the facilities on notice as to our records access authority. In each case, the facility provided the requested records shortly after filing of the litigation.

B. Litigation/Class Actions

1. Number of individuals potentially impacted by changes as a result of PAIR litigation/class action efforts 20150

2. Number of individuals named in class actions 1

Describe your litigation/class action activities. This lawsuit was brought on behalf of a woman who is blind and dependent on government benefits. The state requires beneficiaries to regularly report income and other information. The forms provided to beneficiaries are in standard format. The client needed them to be in Braille, but the state refused.Suit was filed and the state agreed to change its policies and now provides required state forms to beneficiaries in Braille.The National Federation of the Blind estimates the prevalence rate of blindness in adults to be 2.3%. The Michigan Department of Health and Human Services provides food stamps to 876,000 recipients each month. Therefore, the estimated number of individuals who will benefit from this change in policy is 20,150.

Part V. PAIR'S Priorities and Objectives

A. Priorities and Objectives for the Fiscal Year Covered by this Report

For each of your PAIR program priorities for the fiscal year covered by this report, please:

Identify and describe priority.
Identify the need, issue or barrier addressed by this priority.
Identify and describe indicators PAIR used to determine successful outcome of activities pursued under this priority.
Explain whether pursuing this priority involved collaborative efforts by other entities. If so, describe this collaboration.
Provide the number of cases handled under the priority. Indicate how many of these, if any, were class actions.
Provide at least one case summary that demonstrates the impact of the priority.

Priorities and Objectives Part V. PAIR'S Priorities and ObjectivesA. Priorities and Objectives for the Fiscal Year Covered by this ReportFor each of your PAIR program priorities for the fiscal year covered by this report, please:1.Identify and describe priority.2.Identify the need, issue or barrier addressed by this priority.3.Identify and describe indicators PAIR used to determine successful outcome of activities pursued under this priority.4.Explain whether pursuing this priority involved collaborative efforts by other entities. If so, describe this collaboration.5.Provide the number of cases handled under the priority. Indicate how many of these, if any, were class actions.6.Provide at least one case summary that demonstrates the impact of the priority.A. Priority: Eliminate Abuse and Neglect1.Describe the priority.Prevent consumers from being subjected to restraint and/or seclusion or otherwise abused and/or neglected.2.Identify the need, issue, or barrier addressed by this priority.People with disabilities too often are subjected to abuse and/or neglect. This can occur in facilities or in the community. In addition, the use of restraint and/or seclusion is an ongoing problem, particularly in schools and some types of facilities that are virtually unregulated. Abuse/neglect is especially prevalent in nursing facilities.3.Identify and describe indicators PAIR used to determine successful outcome of activities pursued under this priority.If abuse and/or neglect is confirmed, whether appropriate corrective measures are taken to prevent future incidents.4.Explain whether pursuing this priority involved collaborative efforts by other entities. If so, describe this collaboration.MPAS works collaboratively with the Office of Recipient Rights of the Michigan Department of Health and Human Services, the State Long Term Care Ombudsman, and licensing and certification agencies.5.Provide the number of cases handled under this priority. Indicate how many of these, if any, were class actions.Thirty cases, no class actions.Note: PAIR funding is used to support much of this project. Individual cases are funded by the relevant funding source.6.Provide at least one case summary that demonstrates the impact of the priority.MPAS investigated the treatment of a resident in a nursing facility. After investigation, a complaint was filed with the Bureau of Professional Licensing. The complaint alleged that nursing staff failed to properly and timely assess the resident's health and to report changes to the facility physician. These failures lead to the death of the resident.While MPAS promptly filed its complaint against the two LPNs who should have reported a change in the resident's condition, it took BPL approximately one year to finalize its investigation. BPL found both LPNs to have been negligent, placed both on probation, imposed a fine on both, and required both to take continuing education. However, the delay between filing of the

B. Priorities and Objectives for the Current Fiscal Year

Please include a statement of priorities and objectives for the current fiscal year (the fiscal year succeeding that covered by this report), which should contain the following information:

a statement of each prioirty;
the need addressed by each priority; and;
a description of the activities to be carried out under each priority.

B. Priorities and Objectives for the Current Fiscal Year B. Priorities and Objectives for the Current Fiscal YearPlease include a statement of priorities and objectives for the current fiscal year (the fiscal year succeeding that covered by this report), which should contain the following information:1.a statement of each priority;2.the need addressed by each priority; and;3.a description of the activities to be carried out under each priority.B. Priority: Eliminate Abuse and Neglect1.Describe the priority.Prevent consumers from being subjected to restraint and/or seclusion or otherwise abused and/or neglected.2.Identify the need, issue, or barrier addressed by this priority.People with disabilities too often are subjected to abuse and/or neglect. This can occur in facilities or in the community. When abuse/neglect occurs in a nursing facility and is investigated by the state agencies, there are frequently long delays between the time when a complaint is filed and sanctions are imposed. Those delays mean that staff ultimately found to have committed abuse and/or neglect are allowed to continue working in a nursing facility with residents who are vulnerable individuals.In addition, the use of restraint and/or seclusion is an ongoing problem, particularly in schools and some types of facilities where regulations are ineffective in curtailing these practices.3. Description of the activities to be carried out.Educate policymakers in an effort to establish better measures to protect consumers and to eliminate the use of restraint and/or seclusion; investigate suspected abuse/neglect cases and follow-up as needed; and file appropriate litigation.B. Priority: Increase the Protection of Individual Rights, Independence, and Self-Determination.1.Describe the priority.Advocate for effective systems and proceedings to safeguard the rights of consumers.2.Identify the need, issue, or barrier addressed by this priority.People with disabilities frequently have their civil rights compromised by overreaching guardians and representative payees. In Michigan, as of calendar year 2015, there are approximately 33,000 adults under a guardianship order. This does not include individuals with a developmental disability. There is little to no oversight of these guardians, many of whom have 100 or more individuals for whom they have been appointed.As an example of the extent of the authority granted to these guardians, Michigan law was amended three years ago to allow guardians to execute do-not-resucitate orders for their wards. All that the guardian must do is to confer with a physician, meet with their ward, and determine whether the ward is capable of meaningful communication (an undefined term.) The guardian may then sign the order. All this occurs with no court oversight.3. Description of the activities to be carried out.Advocacy in individual cases involving allegations of interference with the exercise of the right to vote, denial of marriage, or the loss of other civil rights

Part VI. Narrative

Narrative

At a minimum, you must include all of the information requested. You may include any other information, not otherwise collected on this reporting form that would be helpful in describing the extent of PAIR activities during the prior fiscal year. Please limit the narrative portion of this report, including attachments, to 20 pages or less.

The narrative should contain the following information. The instructions for this form outline the information that should be contained in each section.

Sources of funds received and expended
Budget for the fiscal year covered by this report
Outline the budget for the fiscal year covered by the report (prior fiscal year), as well as a projection for the current fiscal year. Be sure to include a breakdown of dollars expended/allotted for: administrative costs (i.e., personnel salaries, equipment, etc.); services to individuals; and other expenses (i.e., staff training, travel, etc.)
Description of PAIR staff (duties and person-years)
Involvement with advisory boards (if any)
Grievances filed under the grievance procedure
Coordination with the Client Assistance Program (CAP) and the State long-term care program, if these programs are not part of the P&A agency

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Certification

Signed

Signed? Yes

Signed by Elmer L. Cerano

Title MPAS Executive Director

Signed date Thu, 12/15/2016 - 00:00

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