RSA-509 - Protection & Advocacy of Individual Rights (PAIR) Program Performance Report

District of Columbia (DC-RSA / UNIVERSITY LEGAL SERVICES) - H240A110059 - FY2011

General Information

Designated Agency Identification

NameUniversity Legal Services
Address220 I St NE 130
Address Line 2
CityWashington
StateDistrict of Columbia
Zip Code20002
E-mail Addressjbrown@uls-dc.org
Website Addresshttp://www.uls-dc.org
Phone202-547-0198
TTY 202-547-2657
Toll-free Phone877-221-4638
Toll-free TTY
Fax202-547-2662
Name of P&A Executive DirectorJane Brown
Name of PAIR Director/CoordinatorMarjorie Rifkin
Person to contact regarding reportMarjorie Rifkin
Contact Person phone202-547-0198
Ext.128

Part I. Non-Case Services

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

Multiple responses are not permitted.

1. Individuals receiving I&R within PAIR priority areas93
2. Individuals receiving I&R outside PAIR priority areas179
3. Total individuals receiving I&R (lines A1 + A2)272

B. Training Activities

1. Number of trainings presented by PAIR staff6
2. Number of individuals who attended training (approximate)148

ULS staff conducted "Know Your Rights" trainings and presentations at the following nursing homes and a senior citizen day program regarding community-based alternatives to nursing homes, the Day v District of Columbia class action lawsuit, and ADA access rights to public accommodations, and governmental facilities and services:

Rock Creek Manor Nursing Home - 33 participants Deanwood Nursing Home - 29 Hadley Nursing Home - 5 Washington Center on Aging Svces- 14 Vida Senior Day Program - 22

At each training event, ULS staff distributed materials about home and community-based alternatives to nursing home placement, accessible housing options, and TBI resource guides, and presented the film "Your Home, Your Choice" which ULS produced. We prepared and shared a comprehensive power point presentation for this training that covered substantive advocacy steps about accessing housing and community-based services for residents seeking to move back to the community.

ULS also presented to 45 advocates, lawyers and governmental representatives at an all-day workshop at the NDRN conference about advocacy and litigation for home and community-based alternatives to nursing home placement.

C. Information Disseminated to the Public

1. Radio and TV appearances by PAIR staff5
2. Newspaper/magazine/journal articles4
3. PSAs/videos aired1
4. Hits on the PAIR/P&A website70,000
5. Publications/booklets/brochures disseminated10
6. Other (specify separately)6

Narrative

ULS successfully publicized the class action lawsuit Day v. District of Columbia in conjunction with our filing in federal court in December 2010. The case garnered the following major publicity:

Four Newspapers: 1)Washington Post (http://www.washingtonpost.com/wp-dyn/content/article/2010/12/22/AR2010122204704.html). 2)Associated Press 3)Washington City Paper 4)New York Daily News (http://www.nydailynews.com/topics/Washington+DC)

Two local public radio and news stations: (https://wamu.org/news/10/12/23/people_with_disabilities_sue_dc)

Three television stations: 1) (http://www.wusa9.com/news/local/story.aspx?storyid=127266 2) http://www.myfoxdc.com/dpp/news/dc/lawsuit-claims-dc-failing-nursing-home-residents-122310 3) http://www.abc2news.com/dpp/news/national/lawsuit-claims-dc-failing-nursing-home-residents.

Six web-based blogs sponsored by non-profit agencies and law firms also covered the Day filing.

Part II. Individuals Served

A. Individuals Served

Count individual once per FY. Multiple counts not permitted for lines A1 through A3.

1. Individuals still served as of October 1 (carryover from prior FY)14
2. Additional individuals served during the year27
3. Total individuals served (lines A1 + A2)41
4. Individuals w. more than 1 case opened/closed during the FY. (Do not add this number to total on line A3 above.)2

B. Individuals served as of September 30

Carryover to next FY may not exceed total on line II. A.3 above 14

C. Problem Areas/Complaints of Individuals Served

1. Architectural accessibility2
2. Employment0
3. Program access1
4. Housing11
5. Government benefits/services22
6. Transportation0
7. Education1
8. Assistive technology0
9. Voting0
10. Health care5
11. Insurance0
12. Non-government services0
13. Privacy rights0
14. Access to records0
15. Abuse1
16. Neglect0
17. Other0

D. Reasons for Closing Individual Case Files

1. Issues resolved partially or completely in individual favor22
2. Other representation found1
3. Individual withdrew complaint2
4. Appeals unsuccessful0
5. PAIR Services not needed due to individual's death, relocation etc.1
6. PAIR withdrew from case1
7. PAIR unable to take case because of lack of resources0
8. Individual case lacks legal merit0
9. Other3

Please explain

ULS advocated on behalf of two individuals whose issues were not pursued further. One individual was transferred to a nursing home in Maryland; the other individual was not eligible for any Medicaid home health services due to his financial status.

ULS represents a plaintiff class of approximately 500 to 2,900 nursing home residents in Day v. District of Columbia seeking transition assistance from the DC government to move back to the community with the services and supports they need under the DC Medicaid State Plan and Medicaid Waiver Program for People who are Elderly and/or have Physical Disabilities.

E. Intervention Strategies Used in Serving Individuals

List the highest level of intervention used by PAIR prior to closing each case file.

1. Technical assistance in self-advocacy5
2. Short-term assistance18
3. Investigation/monitoring0
4. Negotiation0
5. Mediation/alternative dispute resolution0
6. Administrative hearings1
7. Litigation (including class actions)1
8. Systemic/policy activities4

Part III. Statistical Information on Individuals Served

A. Age of Individuals Served as of October 1

Multiple responses not permitted.

1. 0 - 40
2. 5 - 221
3. 23 - 5921
4. 60 - 645
5. 65 and over14

B. Gender of Individuals Served

Multiple responses not permitted.

1. Females23
2. Males18

C. Race/Ethnicity of Individuals Served

For individuals who are non-Hispanic/Latino only

1. Hispanic/Latino of any race2
2. American Indian or Alaskan Native0
3. Asian0
4. Black or African American36
5. Native Hawaiian or Other Pacific Islander0
6. White3
7. Two or more races0
8. Race/ethnicity unknown0

D. Living Arrangements of Individuals Served

Multiple responses not permitted.

1. Independent23
2. Parental or other family home2
3. Community residential home1
4. Foster care0
5. Nursing home15
6. Public institutional living arrangement0
7. Private institutional living arrangement0
8. Jail/prison/detention center0
9. Homeless0
10. Other living arrangements0
11. Living arrangements not known0

E. Primary Disability of Individuals Served

Identify the individual's primary disability, namely the one directly related to the issues/complaints

1. Blind/visual impairment1
2. Deaf/hard of hearing1
3. Deaf-blind0
4. Orthopedic impairment30
5. Mental illness0
6. Substance abuse0
7. Mental retardation0
8. Learning disability0
9. Neurological impairment2
10. Respiratory impairment0
11. Heart/other circulatory impairment0
12. Muscular/skeletal impairment5
13. Speech impairment0
14. AIDS/HIV0
15. Traumatic brain injury0
16. Other disability2

Part IV. Systemic Activities and Litigation

A. Systemic Activities

1. Number of policies/practices changed as a result of non-litigation systemic activities8

2. Number of individuals potentially impacted by policy changes50,000

Describe your systemic activities. Be sure to include information about the policies that were changed and how these changes benefit individuals with disabilities. Include case examples of how your systemic activities impacted individuals served.

A. Participation in Advocacy Coalition for Smooth Mayoral Transition:

Description: ULS participated in a coalition of advocates that met with incoming Mayor Gray’s transition team to urge rescission of the proposed reduction in the number of hours of Medicaid personal care assistance (PCA) and expand use of the Medicaid home and community-based waiver programs, rather than placement in nursing facilities and other institutions. Other issues raised by the transition coalition were removal of barriers to enable people to access essential public benefits such as food stamps and Medicaid, funding of interim disability assistance, and the need for expansion of the Medicaid health care provider base.

Policies changed: In March 2011, DC Medicaid officials rescinded the proposed reduction in personal care assistance (PCA) service hours.

Benefits: People with disabilities (e.g., people with TBI and developmental disabilities) who rely on Medicaid PCA services who may not qualify for Medicaid Waiver services or DDS services.

This was a systemic effort; case examples are noted below under the specific priority areas.

B. Improper Termination of Home Health Services:

ULS successfully challenged the DC department of Healthcare Finance’s (DHCF’s) persistent, systemic illegal termination of Medicaid waiver services on behalf of 21 people with physical disabilities and senior citizens. Most of the beneficiaries terminated without proper notice or due process, due to the failure of DHCF to process the necessary paperwork for recertification of their Medicaid waiver services. Consequently, many dually eligible Medicare/Medicaid beneficiaries lost Medicaid coverage, in addition to waiver services, since their Medicaid coverage was due to their participation in the waiver program. ULS cited the myriad violations of federal Medicaid and local law and urged DHCF to authorize the restoration of services and Medicaid coverage.

Despite ULS’ prior provision of model due process notices, DHCF has not yet adopted a comprehensive notice nor has it enforced due process or notice requirements through its Medicaid waiver and State Plan home health service providers. Case examples: ULS successfully advocated for the restoration of waiver home health services to BC, a 49-year-old man with quadriplegia, who received an insufficient termination notice due to DC Medicaid’s failure to timely process his waiver recertification, and despite his submission of updated income statements and doctor’s orders to continue his waiver participation.

C. Investigation of Olmstead Violations by DC government: ULS submitted critical comments relating to the District’s notice of its intention to establish a waiting list for the Medicaid Waiver Program for People who are Elderly and/or have Physical Disabilities (EPD Waiver). ULS cited the District’s failure to reserve EPD Waiver Program slots for people in nursing facilities, or people in the community who may lose their waiver slots following hospitalization, thereby exacerbating its violation of Olmstead and Title II of the ADA. Previously, the District submitted a simple application to CMS to expand the number of EPD Waiver slots, rather than establish a wait list. In addition, ULS pointed out that DHCF unnecessarily filled the waiver slots in the EPD Waiver Program by shifting hundreds of people from the PCA State Plan to the Waiver. Through the Day v. District of Columbia litigation, ULS is exposing the District’s violation of Title II of the Americans with Disabilities Act (ADA) by failing to provide transitional assistance to people with disabilities in nursing facilities to enable them to exercise their choice to return to the community with the services and supports they need. During this fiscal year, ULS interviewed over 200 individuals in nursing facilities to assess their interest in returning to the community and their need for community services and supports, conducted discovery to substantiate the District’s significant under-utilization of Medicaid Waiver services and the Money Follows the Person Program. Case examples: ULS represents B.J., E.D., and R.F., who are named plaintiffs in Day v. District of Columbia, a class action filed by ULS under the ADA and the Supreme Court’s Olmstead decision. Among the legal claims ULS raised and investigated was the District’s failure to provide transitional assistance to people with physical disabilities in nursing facilities seeking to move back to the community. The District has not utilized the Money Follows the Person Program, which was originally funded by HHS to assist 1,100 people transition from institutions over a five year period. Now in its fifth year, the District has only assisted three people in moving out of nursing facilities.

D. Diabetes Care in DC Public Schools: In September 2011, ULS launched an investigation into the failure of DC Public Schools (DCPS) to provide diabetes care to students with Type I diabetes. DCPS’ practice is to send children with diabetes home from school when the nurse is absent or to require parents to stay with their children at school to administer their diabetes care. DCPS fails to train or authorize school personnel other than nurses to serve as backup coverage to the assigned nurses. ULS sent a comprehensive complaint letter to the DCPS Chancellor and other officials and began an outreach effort to families, health care professionals, and other advocacy organizations to identify affected children. ULS also met with the DC Board of Nursing about the delegation of nursing tasks including diabetes care for people with disabilities living at home as well as children with diabetes in schools. Case example: ULS is fighting on behalf of L.T., a nine-year-old public school student with diabetes, to get the diabetes care she needs at school, in addition to the compensatory time for the 10 days that DCPS improperly sent her home, and the field trip that she was kept from attending due to the nurse’s absence.

E. Personal Care Assistance and Home Care Nursing Duties: ULS drafted critical comments on two sets of proposed regulations that limited the scope of duties of personal care assistants and home health aides. ULS pointed out the lack of conformity with the ADA and with the nurse delegation provisions of the proposed regulations regarding home health aides. We also criticized the severe limitation on tasks which nurses can delegate to home health aides to meet the needs of the Medicaid and Waiver recipients who rely on home health aides for their care in the community. Among the services ULS urged DHCF to allow aides to handle was bowel and bladder care and diabetes care. Policy changed: The DC Board of Nursing agreed to incorporate many of ULS’ comments and concerns prior to finalizing the regulations. Benefits: People with disabilities would get the services they need through home health aides. Case example: ULS successfully advocated for bowel and bladder care for ML, a 46-year-old man with quadriplegia whose home health agency terminated his nursing services. ULS assisted Mr. L in identifying a different nursing agency to perform his routine bowel and bladder care. ULS filed a complaint with the DC licensing agency regarding the original nursing agency’s failure to provide medically necessary care. In Mr. L’s case, the nurse initially refused to perform the bowel and bladder care. If, however, DHCF allowed nurse delegation of such tasks, home health aides would typically perform them.

F. Level of Services Available in the Personal Care Assistance Medicaid Program:

Description: ULS organized a coalition of advocates to challenge a proposed drastic reduction in Medicaid State Plan personal care assistance (PCA) to a firm limit of 520 hours from 1,040 hours per year with additional hours upon prior authorization.

Policies changed: In March 2011, DC Medicaid officials rescinded the proposed reduction in PCA service hours.

Benefits to individuals with disabilities: PCA services are essential for people with physical disabilities and those with traumatic brain injuries and senior citizens who are not served under any other home health or waiver programs. We helped to restore the full level of PCA services for those who need more than 1,040 hours per year. We also helped restore State Plan services for those Medicaid PCA beneficiaries who need 8 hours of PCA services per day or less, but may not need a nursing home level of care to qualify for EPD Waiver services.

Case examples: We helped restore the full level of PCA services for those who need more than 1,040 hours of PCA services per year to help with their activities of daily living. ULS assisted A.M., a 45-year-old woman with mobility disabilities and TBI, in restoring and promoting her PCA services under the Medicaid State Plan. We also assisted D.S., a 42-year-old woman with mobility disabilities, in taking the necessary steps to participate in the waiver program. Neither Ms. M nor Ms. S received legally sufficient termination notices from DC Medicaid; both had submitted necessary paperwork to continue their services, but DC Medicaid never processed their recertification or timely authorized their services until ULS got involved.

G. Voting Access ULS continues to advocate for 100% accessibility of DC polling precincts following our Election Day accessibility surveys and exposure of ongoing barriers to voting access by people with disabilities. During this fiscal year, we issued a comprehensive report reflecting our findings of inaccessible polling sites during the Mayoral election and a shorter report about barriers at a special election in April 2011. ULS continues to make recommendations for resolving the barriers. We also met with the new, but now-departed Board of Elections director and his staff in an effort to achieve 100% accessibility for voters with disabilities.

In response to ULS’ advocacy, the BOEE relocated three inaccessible polling places to more accessible locations.

There are no case examples to relate under this initiative.

H. Community Restaurant Accessibility:

ULS sent letters to 16 new restaurants along the revitalized H Street NE corridor to advise them of their obligations to comply with Title III of the ADA and the ADAAG (ADA Access Guidelines) which require they provide a wheelchair-accessible entrance and one accessible bathroom if site conditions make access readily achievable.

As a result of ULS’ advocacy, three of the restaurants have improved their accessibility.

There are no case examples to relate under this initiative.

B. Litigation/Class Actions

1. Number of individuals potentially impacted by changes as a result of PAIR litigation/class action efforts5,000
2. Number of individuals named in class actions14

Describe your litigation/class action activities. Explain how individuals with disabilities benefited from your litigation activities. Be sure to include case examples that demonstrate the impact of your litigation.

Day v. District of Columbia:

1. Individuals potentially impacted: Day v. District of Columbia, a class action lawsuit filed by ULS in December 2010, will benefit up to 3,000 people with physical disabilities in nursing facilities who seek to transition to the community with the services and supports they need.

2. ULS named 5 individuals as named plaintiffs.

3. Description: The Day case plaintiffs seek injunctive relief , i.e., a Court order requiring the District to provide the following to residents of nursing facilities: information about home and community-based alternatives, transition assistance (to obtain identification documents and to complete housing applications) and access to services and supports that people need in order to live in the community. ULS is co-counseling with AARP Foundation Litigation and Arent Fox LLP; we are litigating the case under the PAIR and PAIMI grants.

During this fiscal year, ULS filed the Day law suit in federal court, amended the complaint in March 2011, conducted comprehensive discovery of 90,000 documents produced by the District, and medical records produced by the nursing facilities, arranged medical consultant interviews of named plaintiffs, conducted depositions of District Medicaid officials following the District’s filing of its Motion to Dismiss or, in the Alternative, Motion for Summary Judgment. ULS filed its opposition to the Motion to Dismiss/Summary Judgment Motion on September 1, 2011. The U.S. Department of Justice filed its Statement of Interest in support of plaintiffs’ position. We are awaiting the Court’s decision on the Motion to Dismiss/Summary Judgment Motion.

4. Benefits to individuals: Under the injunctive relief sought in Day, people with physical disabilities in nursing facilities who seek to transition to the community will get the transition assistance they need.

5.Case example: B.J. is a 53-year-old woman with mobility disabilities, seizures, among other disabilities who is a named plaintiff in the Day lawsuit. She had lived in a DC nursing facility for over 4-1/2 years prior to finally being discharged with the services she needed under the DC Money Follows the Person Program in June 2011. Ms. J received a housing subsidy through her MFP participation, moved into her own apartment, and gets 8 hours of home health services daily.

Young v. DC Housing Authority:

1.People potentially impacted: Approximately 1,000 people have already benefited. Many more people who use wheelchairs will have access to wheelchair accessible, integrated public housing units as a result of the Young case. This will enable them to live in the community instead of in nursing facilities and other institutions.

2. ULS named nine plaintiffs in Young v. DC Housing Authority, a class action law suit seeking injunctive relief to require the DC Housing Authority to comply with Section 504 of the Rehabilitation Act by renovating or building at least 5% of public housing units to be wheelchair accessible.

3.Description: In 2001, ULS filed a class action lawsuit against the DC Housing Authority under Section 504 for wheelchair accessibility in public housing resulting in a consent order requiring the construction or renovation of 565 fully accessible public housing units. The consent decree requires DCHA to complete all 565 units by 2013. During FY 2011, ULS inspected three public housing units to determine compliance with federal access standards.

4. Benefits thus far: DCHA has completed over 500 accessible units. We estimate that approximately 1,000 individuals have moved into the accessible public housing units created in the past 10 years under the Young case.

5.Case examples: ULS assisted P.Y., a 58-year-old woman in a nursing facility who relied on a wheelchair and had multiple disabilities including deep vein thrombosis, decubitis ulcers, and Chron’s disease, to lease a wheelchair accessible 5 bedroom town home through the DC Housing Authority. This enabled Ms. Y to move back to the community in April 2011 to live with her daughter and grandchildren after more than 5 years in a nursing facility.

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:

  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.

Objective: Advocate on behalf of people with disabilities to ensure their access to public and subsidized housing, public accommodations, and DC government services and supports in the most integrated settings appropriate to their needs.

Priorities: 1.A. Pursue legal advocacy to enforce Section 504 of the Rehabilitation Act in federally-funded private housing developments, and the Fair Housing Act in privately owned and financed housing in the District of Columbia to make them accessible to, or otherwise accommodate, individuals with mobility disabilities.

2.A.Need, issue, barrier: Accessible housing is key to enabling people with disabilities who choose to transition out of nursing facilities and other institutions back to the community, and to remain in the community. ULS successfully advocated on behalf of several tenants in privately managed properties to comply with Section 504 and accommodate people with disabilities.

3.A. Indicators to determine successful outcome: ULS gauges success based on the accommodations provided to the individuals with disabilities we serve.

4.A. Collaboration: Private housing provider/landlords, DC Housing Authority, home health agencies.

5.A. Cases: (indicate class actions): ULS handled 4 cases under this priority.

6.A. Case summary: ULS successfully advocated for a landlord to install a strobe-activated intercom entry system in the apartment of R.H., a 52-year-old woman who is deaf, ventilator-dependent and has limited mobility. ULS reminded the landlord of his obligation under the Fair Housing Act and Section 504 of the Rehabilitation Act and he installed the strobe intercom system in Ms. H.’s apartment. Without the strobe intercom, Ms. H was unable to buzz her home health nurse and aides into her home to perform her care.

ULS advocated on behalf of ST, a senior citizen with limited mobility who was at risk of losing her housing subsidy voucher because her landlord initially refused to lease a renovated unit to her after she gave notice of vacating her inaccessible unit. ULS urged her landlord and the DC Housing Authority to accommodate her and allow her to lease the accessible unit and transfer her voucher; we ultimately referred her to a wheelchair accessible building where she leased an accessible 1 bedroom unit with her voucher. ULS also advocated on behalf of DS, a 42-year-old woman who uses a wheelchair, to transfer her housing subsidy voucher to a wheelchair accessible apartment after her existing landlord failed inspections and was terminated from the housing subsidy program. ************************************************************ 1.B. Work to ensure that public accommodations, polling sites, and governmental facilities are accessible to people with mobility, hearing and visual disabilities in the District of Columbia under the Americans with Disabilities Act.

2.B. Need, issue, barrier: People with disabilities seek to live fully integrated lives in the community as is their right under the ADA. During this year, ULS submitted a comprehensive complaint to the DC Public Schools chancellor and other school officials regarding its failure to provide diabetes care to L.T., an 8-year-old public school child when school nurses are absent. We detailed federal and local legal obligations under Section 504 of the Rehabilitation Act, the ADA and IDEA. DCPS’ practice is to send children with type 1 diabetes home from school when the nurse is absent or to require parents to stay with their children at school to administer their diabetes care. Although DC law allows DCPS to utilize trained unlicensed school personnel for diabetes care, DCPS fails to train or authorize such personnel as backup. ULS is fighting for L.T. to get the diabetes care she needs at school, and compensatory time for the days DCPS improperly sent her home and the field trip she was denied due to lack of a nurse.

ULS also successfully advocated for the relocation of three inaccessible polling sites and issued a comprehensive report on voting accessibility during DC mayoral election and a smaller report on the special neighborhood-based elections.

In addition, ULS sent letters to 16 new restaurants along the newly-redeveloped H Street NE corridor to advise them of their obligations to comply with Title III of the ADA and the ADAAG (ADA Access Guidelines) which require they provide a wheelchair-accessible entrance and accessible bathroom if site conditions make access readily achievable. As of this report, three restaurants have improved their accessibility following ULS’ letter. ULS also challenged the lack of accommodations by a physician’s medical office affiliated with a major hospital.

3.B.Indicators to determine successful outcome: ULS judges success on this indicator based on the level of improved access to DC facilities and services.

4.B. Collaboration: DC Board of Elections, DC Board of Nursing, Children’s Law Center, American Diabetes Association, Juvenile Diabetes Research Foundation, Howard University Hospital Diabetes Treatment Center, the Georgetown University Hospital, Children’s Hospital, Legal Aid Society, Legal Clinic for the Homeless. 5.B.ULS handled 1 case under this priority while handling a number of systemic issues that will impact many other individuals.

6.B. Case summary: In September 2011, ULS submitted a comprehensive complaint to the DC Public Schools (DCPS) chancellor and other officials regarding their failure to provide diabetes care to L.T., an 8-year-old public school child, when school nurses are absent. ULS detailed federal and DC legal obligations under Section 504 of the Rehabilitation Act, the Americans with Disabilities Act and the IDEA. Although DC law allows DCPS to utilize trained unlicensed school personnel for diabetes care, DCPS fails to train or authorize such personnel as backup to the assigned nurses. ULS is fighting for L.T. to get the diabetes care she needs at school, and compensatory time for the 10 days DCPS improperly sent her home and the field trip she was denied due to lack of a nurse. ULS is contemplating which form of legal action and forum to pursue on behalf of L.T. Before taking action, ULS is attempting to identify additional children harmed by DCPS’ practice by conducting outreach to families, health care professionals, and other advocacy organizations.

************************************************************** 1.C. Represent plaintiff class members with mobility disabilities under the Young v. DC Housing Authority case to ensure they receive interim housing options and monetary remedies pending the completion of the remaining 90 accessible public housing units pursuant to the July 2008 Amended Consent Order.

2.C.Need, issue, barrier: Accessible public housing is critically important for people who rely on wheelchairs to move out of nursing facilities and remain in the community. ULS continues to monitor the DC Housing Authority’s completion of the 565 fully wheelchair accessible public housing units mandated by the Amended Consent Order, and the interim housing and compensation due to plaintiff class members for the delay in completion of the accessible units. During this year, ULS inspected 3 completed accessible units to determine if they comply with federal access guidelines. ULS also assisted scores of individuals to complete their DCHA applications and document requirements in order to lease the accessible units. We assisted many of these individuals through our intake and provision of information and forms for completion and submission to the DC Housing Authority. We also assisted several individuals in restoring their housing subsidy vouchers through the DC Housing Authority and leasing accessible units with their vouchers. ULS continued to convey to HUD our concerns about class members’ public housing status as occupants in privately-managed housing developments with respect to maintaining their rights to transfer within the public housing system.

3.C.Indicators to determine successful outcome: ULS bases its success on the number of wheelchair accessible units built or renovated by DC Housing Authority to reach full compliance with the consent order.

4.C. Collaboration: DC Housing Authority, private property management company landlords, nursing home discharge planners.

5.C. ULS handled 8 individual cases and 1 class action lawsuit under this priority.

6.C. Case summary: ULS assisted P.Y., 58, an individual with Chron’s Disease, who formerly resided in a nursing home. We helped her request wheelchair accessible public housing unit as a reasonable accommodation and move into a larger public housing unit with her daughter. As a result of ULS assistance, P.Y. moved out of a nursing home into a 5 bedroom wheelchair accessible public housing unit with her daughter and grandchildren.

ULS advocated successfully with DCHA on behalf of A.L., a 68 year old woman who uses a wheelchair, to enable her to upgrade her housing subsidy voucher from a 1 bedroom to a 2 bedroom voucher to accommodate Ms. L and a live-in aide. We also helped Ms. L. locate and lease an accessible unit with her voucher by serving as liaison with DCHA to ensure proper documentation was submitted as necessary. ********************************************* 1.D. Advocate and/or litigate to require the DC Department of Health Care Finance and the DC Office on Aging to ensure access to quality home-based personal care services and supports through the Elderly and Physical Disabilities (EPD) Medicaid Waiver Program and the DC Medicaid State Plan to people with disabilities seeking alternatives to nursing home placement. Provide training, informational materials, and assistance to individuals, including those in the Latino community, in obtaining and maintaining these services in the community.

2.D. Need, issue, barrier: Quality home health services are essential to most of the individuals in nursing facilities who would prefer to transition back to the community as is their right under the integration mandate of Title II of the ADA. Following years of advocacy and public education about the rights of individuals with disabilities to live in the community, and the services and supports available in the community, ULS filed Day v. District of Columbia, a major injunctive class action lawsuit on behalf of 500 to 3,000 people with physical disabilities and (under the PAIMI grant) those with mental illness in nursing facilities who seek to move back to the community. The case seeks a court order requiring the District to provide transition assistance, services and supports to enable people to live in the community. Through the Day litigation, ULS conducted document discovery, record reviews and depositions and learned that the District only transitioned 3 people from nursing facilities under the Money Follows the Person, and established a waiting list for participation in the EPD Waiver Program, after transferring hundreds of participants from the State Plan PCA Program to the EPD Waiver, thus filling the waiver slots.

During this year, ULS successfully challenged DC’s effort to slash the State Plan PCA Program benefits in half. However, during the process of proposing the reduction, DC unnecessarily transferred hundreds of people from the PCA Program to the Waiver Program. ULS assisted several individuals in restoring their Medicaid coverage and Waiver Program services following improper terminations without adequate notice and due process due to DC’s failure to process their certification paperwork.

3.D. Indicators to determine successful outcome: The extent of success on this indicator is based on the level of individuals’ access to home health services, as well as medical equipment and other services and supports in the community.

4.D. Collaboration: AARP Foundation Litigation, Long-term Care Ombudsman Program, Arent Fox LLP, DC Department of Healthcare Finance, Health Regulations Licensing Administration, nursing facility staffs, home health agency providers, medical equipment providers.

5.D. ULS handled 29 individual cases and 1 class action case under this priority. Unlike prior years, ULS did not open as many individual cases of class members in nursing facilities because we expect the District government to fulfill its ADA/Olmstead obligations to the class by providing hands-on transition assistance.

6.D. ULS successfully advocated for M.T., a 49-yr-old woman with multiple sclerosis, to get a motorized wheelchair following months of delay and miscommunications between nursing facility clinical staff and an equipment company. Ultimately, ULS helped M.T., a Day class member, to move from the nursing facility into a fully accessible apartment in the community with the services and supports she needs. Ms. T had previously operated a boutique that she lost, along with her home, when her MS progressed and she lacked health insurance to cover the bills and mortgage.

In addition to Ms. T., Day class representative B.J., a 53-year-old woman with seizures and mobility limitations, moved out of a nursing facility after four and a half years, into her own apartment in June 2011. ***************************************************** 1.E. Investigate and remedy allegations of abuse and/or neglect against people with disabilities who transition from nursing homes and/or live in the community.

2.E. Need, issue, barrier: This priority aims to investigate and resolve abuse and neglect in order to enable people with disabilities to live safely in the community with the dignity that they are entitled to. ULS submitted a complaint to the administrators of two DC nursing facilities regarding their violations of the Nursing Home Reform Act and federal law governing P&A authority for their obstructive conduct which impeded ULS’ access and interviews with individuals at the nursing facilities. In both cases, the administrators vowed to allow ULS full access to nursing facility residents.

3.E. Indicators to determine successful outcome: ULS judges success on this indicator based on the resolution of abuse and neglect allegations.

4.E. Collaboration: DC long-term care ombudsman’s office, DC nursing facilities, DC Board of Nursing, Home health agencies, medical equipment companies, DHCF.

5.E. ULS handled 5 cases under this priority.

6.E.Case summary: ULS successfully restored bowel and bladder care for ML, a 46-year-old man with quadriplegia whose home health agency terminated his nursing services. ULS assisted Mr. L in identifying a different nursing agency to perform his routine bowel and bladder care. ULS filed an administrative complaint regarding the original nursing agency’s failure to provide medically necessary care, and also met with the DC Board of Nursing about the issue of bowel and bladder home care. ULS also assisted D.M., a 24 year old individual with a mobility disability and a traumatic brain injury, in obtaining necessary rehabilitative services while he was institutionalized at a local nursing home. ULS is also assisting him to transfer to a different facility that can better meet his rehabilitative needs. ULS filed complaints against 2 nursing facilities for interfering with our access authority to visit with individuals and discuss their rights and level of interest in participating in the Day class action lawsuit we filed on their behalf seeking community integration. In each case, ULS cited the violations of the Nursing Home Reform Act that entitles nursing home residents to unimpeded access to advocates or anyone who visits them, as well as the P&A access authority. In both cases, the nursing facilities took steps to ensure ULS staff’s unimpeded access to residents.

************************************************* 1.F. Provide outreach and education to administrative and policy-making bodies, advocates and to underserved individuals, including those in the Latino community, to promote self-determination, consumer choice, and high quality services for people with disabilities in the most integrated, appropriate settings.

2.F. Need, issue, barrier: ULS conducted trainings and presentations to 148 individuals with disabilities at 4 nursing facilities and a bilingual day program for Latino senior citizens, as well as an all-day workshop for advocates. We also submitted critical comments on 3 sets of proposed regulations governing nursing home discharge procedures, personal care assistant services, home health aide services and nurse delegation to urge revisions that would reflect and promote the rights of individuals with disabilities under the ADA’s integration mandate. ULS staff attorney Marjorie Rifkin presented to 45 advocates at an all-day workshop on advocacy for community transition on behalf of nursing facility residents.

3.F. Indicators to determine successful outcome: ULS bases its success on the extent of outreach to individuals with disabilities, advocates and others.

4.F. Collaboration: Nursing facilities, long-term care ombudsman program, NDRN, senior citizen day programs

5.F. ULS conducted the following trainings and presentations: 4 nursing facility trainings 1 training at a Latino senior citizen day program 1 training at an all-day NDRN-sponsored workshop

We also drafted and submitted critical comments on 3 sets of regulations proposed by DHCF urging more expansive delegation of nursing duties to home health aides and personal care assistants to foster more support for people with disabilities living in the community. We also commented on regulations to urge more comprehensive discharge planning for nursing home residents, and in opposition to the establishment of a waiting list for EPD Waiver Services.

6.F. ULS’ work under this priority involved extensive outreach to individuals with disabilities, but there are no individual cases to report as the individuals we followed up with are reported above under other priorities.

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:

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

OBJECTIVE

Advocate on behalf of people with disabilities to ensure their access to DC government services and supports in the most integrated settings appropriate to their needs, public accommodations, and wheelchair-accessible, integrated, federally-subsidized housing.

Priorities:

A. Represent prospective class members in Day v. District of Columbia to promote their rights under Title II of the Americans with Disabilities Act (ADA) to information about alternatives to nursing facility placement, transitional assistance, and quality home-based personal care services and supports through the Elderly and Physical Disabilities (EPD) Medicaid Waiver Program and the DC Medicaid State Plan to enable them to move out of nursing facilities.

B. Advocate and litigate on behalf of people with disabilities to challenge improper Medicaid home health service terminations and reductions.

C. Pursue legal advocacy to enforce Section 504 of the Rehabilitation Act in federally-funded housing developments in the District of Columbia to make them wheelchair-accessible to individuals with mobility disabilities.

D. Work to ensure that public accommodations, polling sites, and governmental facilities are accessible to people with mobility, hearing and visual disabilities in the District of Columbia under the Americans with Disabilities Act.

E. Represent plaintiff class members with mobility disabilities under the Young v. DC Housing Authority case to ensure the completion of the remaining 90 accessible public housing units pursuant to the July 2008 Amended Consent Order.

F. Investigate and remedy allegations of abuse and/or neglect against people with disabilities who transition from nursing homes and/or live in the community.

G. Provide outreach and education to administrative and policy-making bodies, advocates and underserved individuals to promote self-determination, consumer choice, and high quality services for people with disabilities in the most integrated, appropriate settings.

Part VI. 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.

  1. Sources of funds received and expended
  2. Budget for the fiscal year covered by this report
  3. Description of PAIR staff (duties and person-years)
  4. Involvement with advisory boards (if any)
  5. Grievances filed under the grievance procedure
  6. 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

A. Sources of funds: Received Expended:

Federal(Sec.509) $175,984 $173,540. Total 175,984 173,540.

B.Budget for FY covered by this report: Wages $106606.76 Fringe benefits 21321.34 Materials/supplies 2760.44 Postage 282.33 Telephone 1692.63 Rent/occupancy 21038.00 Travel 1191.44 Bonding/insurance 1439.16 Equipment 5709.85 Indirect costs/consultants 1914.95 Misc. other 9582.96 Total Budget 173539.86 C. PAIR staff: Five part-time professional staff persons Three part-time clerical staff persons D. PAIR staff works closely with advocacy groups and community leaders, but we do not have a formal advisory board governing PAIR activity. E. No grievances were filed. F. ULS collaborated with the long-term care ombudsman program on: developing comments to challenge proposed regulations about the scope of home health aide duties, nursing home discharge procedures, reduction in PCA services, and abuse/neglect complaints against nursing homes, among other issues.

Certification

Signed?Yes
Signed ByJane Brown
TitleExecutive Director
Signed Date12/21/2011