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

Louisiana (Advocacy Center) - H240A110019 - FY2011

General Information

Designated Agency Identification

NameAdvocacy Center
Address8325 Oak St
Address Line 2
CityNew Orleans
StateLouisiana
Zip Code70118
E-mail Addressadvocacycenter@advocacyla.org
Website Addresshttp://www.advocacyla.org
Phone504-522-2337
TTY 855-861-3577
Toll-free Phone800-960-7705
Toll-free TTY855-861-3577
Fax504-522-5507
Name of P&A Executive DirectorLois V. Simpson
Name of PAIR Director/CoordinatorStephanie Patrick
Person to contact regarding reportStephanie Patrick
Contact Person phone504-522-2337
Ext.143

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 areas117
2. Individuals receiving I&R outside PAIR priority areas971
3. Total individuals receiving I&R (lines A1 + A2)1,088

B. Training Activities

1. Number of trainings presented by PAIR staff7
2. Number of individuals who attended training (approximate)2,159

Handouts to 1,000 crime victims assistance personnel on AC basics.

Lecture to 10 consumers and family members of consumers who are blind or have low vision on forming a citizen advisory committee.

Interactive lecture to 45 nursing home staff members on incurred medical expense deductions.

Interactive lecture to 300 Hispanic Americans on general disability rights.

Handouts to 500 senior citizens on AC services.

Interactive lecture to 4 case managers on self-determination issues.

Interactive lecture to 300 attendees on care clinics.

C. Information Disseminated to the Public

1. Radio and TV appearances by PAIR staff1
2. Newspaper/magazine/journal articles33
3. PSAs/videos aired1
4. Hits on the PAIR/P&A website42,641
5. Publications/booklets/brochures disseminated9,952
6. Other (specify separately)0

Narrative

1) Radio and TV appearances by PAIR staff: 1 • Federal Judge: Disabled Can Bring Suit to Trial, KATC.com, 5/19/11

2) Newspaper/magazine/journal articles: 33 • Senate Takes Public Testimony, Advocate, 6/11/11 • Judge says disabled can bring suit to trial, Advocate, 5/19/11 • Disability Advocates: Speak Up About Your Housing Needs, Pushing the Envelope: AC News in Brief, August 17, 2011 — Also posted in email alerts by a number of additional disability groups • Federal Judge: Disabled Can Bring Suit to Trial, San Antonio Express, 5/19/11 • Louisiana Can’t Nix Suit Over Home-Care Cuts, Courthouse News Service, 5/20/11 • Attorney argues cuts to service no violation, Advocate, 4/21/11 • Justice Opposes DHH Cuts, Advocate, 4/20/11 • DDH Hears Revamp Issue, Advocate, 3/31/11 • Disability Support Services Needed, Tri-Parish Times, 3/15/11 • Problems, Confusion Noted in Program to Aid Disabled, Advocate, 2/16/11 • Where the Sidewalk Ends, Tulane Hullabaloo, 1/28/11 • Coalition Promotes Hiring of Disabled, Times Picayune, 11/11/10 • Jindal plan fast-tracks service cuts, Advocate, 12/7/10 • Letter: DHH official questions article, Advocate, 12/16/10 • Letter: Advocacy Center responds to DHH, Advocate, 12/20/10 • At the Breaking Point: Rate Cuts Damaging Home and Community Based Services. TriAngle, October 2010 • After 20 Years, Access is Still a Dream for Many People with Disabilities, TriAngle, October 2010 • CLASS ACTION FILED TO STOP CUTS IN HOME CARE: DHH Forcing People With Disabilities To Be Institutionalized In Order To Receive Care, TriAngle, October 2010 • FMAP Crisis Still Looming, TriAngle, October 2010 • Mardi Gras Accessibility, Pushing the Envelope: AC News in Brief, 3/1/11 • Celebrations for ALL Louisianians - Jazz Fest and Festival International, Pushing the Envelope: AC News in Brief, 4/15/11 • 2011 Legislative Session - Bills that Will Impact You!, Pushing the Envelope: AC News in Brief, 5/4/11 • Show Your Support for Accessibility, Pushing the Envelope: AC News in Brief, 5/4/11 • Celebrations for ALL Louisianians -Breaux Bridge Crawfish Festival, Cochon de Lait Festival, Tunica-Biloxi Pow Wow, and Mudbug Madness, Pushing the Envelope: AC News in Brief, 5/4/11 • 2011 Legislative Session - Devastating Cuts to DHH Under Consideration, Pushing the Envelope: AC News in Brief, 5/25/11 • Judge Rules: Pitts v. DHH Can Proceed, Pushing the Envelope: AC News in Brief, 5/25/11 • Celebrations for ALL Louisianians -Jambalaya Festival, Pushing the Envelope: AC News in Brief, 5/25/11 • Celebrations for ALL Louisianians: Satchmo Summer Fest, Pushing the Envelope: AC News in Brief, 7/27/11 • Volunteer Opportunities in Emergency Shelters, Pushing the Envelope: AC News in Brief, 7/27/11 • DHH Changes EDA Waiver Rules, Pushing the Envelope: AC News in Brief, 7/7/11 • Legislative Update, Pushing the Envelope: AC News in Brief, 7/7/11 • Advocacy Center’s Executive Director Wants to Talk with YOU!, Pushing the Envelope: AC News in Brief, 9/7/11 • Build a Multi-generational Home & Save Money, Pushing the Envelope: AC News in Brief, 9/7/11

3) PSA/videos aired: 1 • Harvesting Hope Video

4) Hits on the PAIR/P&A website: 42,641

5) Publications/booklets/brochures disseminated: 9,952 • Medicaid - 1642 • Legal Status booklet - 1373 • Representation: Procuration and Mandate — 1568 • Abuse and Neglect of the Elderly — 51 • Social Security — 1635 • Age Discrimination in Employment — 152 • Disability Discrimination in Housing - 100 • Choosing a Nursing Home — 237 • SSI — 350 • Higher Education Rights - 50 • Employment Rights - 404 • 10 Steps to Being an Effective Advocate — 457 • Fair Housing for Landlords — 83 • Fair Housing for Landlords (Spanish) - 24 • Fair Housing Fact Sheet — 433 • Fair Housing — 53 • Investigations of Serious Abuse and Neglect - 46 • Help with Other Medical Expenses for Nursing Home Residents — 47 • PAIR — 36 • Rights of Students with Disabilities - 1211

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)76
2. Additional individuals served during the year94
3. Total individuals served (lines A1 + A2)170
4. Individuals w. more than 1 case opened/closed during the FY. (Do not add this number to total on line A3 above.)5

B. Individuals served as of September 30

Carryover to next FY may not exceed total on line II. A.3 above 67

C. Problem Areas/Complaints of Individuals Served

1. Architectural accessibility11
2. Employment2
3. Program access7
4. Housing10
5. Government benefits/services6
6. Transportation5
7. Education5
8. Assistive technology1
9. Voting0
10. Health care98
11. Insurance2
12. Non-government services0
13. Privacy rights8
14. Access to records4
15. Abuse4
16. Neglect37
17. Other2

D. Reasons for Closing Individual Case Files

1. Issues resolved partially or completely in individual favor63
2. Other representation found1
3. Individual withdrew complaint13
4. Appeals unsuccessful3
5. PAIR Services not needed due to individual's death, relocation etc.8
6. PAIR withdrew from case4
7. PAIR unable to take case because of lack of resources2
8. Individual case lacks legal merit14
9. Other0

Please explain

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-advocacy13
2. Short-term assistance41
3. Investigation/monitoring2
4. Negotiation7
5. Mediation/alternative dispute resolution0
6. Administrative hearings36
7. Litigation (including class actions)8
8. Systemic/policy activities1

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 - 225
3. 23 - 5994
4. 60 - 6424
5. 65 and over47

B. Gender of Individuals Served

Multiple responses not permitted.

1. Females98
2. Males72

C. Race/Ethnicity of Individuals Served

For individuals who are non-Hispanic/Latino only

1. Hispanic/Latino of any race3
2. American Indian or Alaskan Native0
3. Asian0
4. Black or African American88
5. Native Hawaiian or Other Pacific Islander0
6. White75
7. Two or more races0
8. Race/ethnicity unknown4

D. Living Arrangements of Individuals Served

Multiple responses not permitted.

1. Independent127
2. Parental or other family home17
3. Community residential home1
4. Foster care0
5. Nursing home20
6. Public institutional living arrangement0
7. Private institutional living arrangement1
8. Jail/prison/detention center4
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 impairment16
2. Deaf/hard of hearing6
3. Deaf-blind0
4. Orthopedic impairment74
5. Mental illness2
6. Substance abuse0
7. Mental retardation0
8. Learning disability1
9. Neurological impairment30
10. Respiratory impairment4
11. Heart/other circulatory impairment26
12. Muscular/skeletal impairment4
13. Speech impairment0
14. AIDS/HIV2
15. Traumatic brain injury5
16. Other disability0

Part IV. Systemic Activities and Litigation

A. Systemic Activities

1. Number of policies/practices changed as a result of non-litigation systemic activities10

2. Number of individuals potentially impacted by policy changes15,800

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.

1. Objective: Ensure that fixed route and paratransit transportation in New Orleans is compliant with the ADA by periodically testing usage of the RTA and fixed route systems, by attending quarterly RTA Board meetings, and through participation on the RTA Special Transit Services Committee.

Result: N.O. paratransit services have improved in past year. Test riding the system has demonstrated good to strong compliance by drivers of boarding and off boarding safety policy/procedure. Driver compliance with securement policy of mobility devices observed to be consistent. Drivers, as a rule, are polite.

RTA fixed route drivers and streetcar operators, unlike paratransit drivers, do not consistently comply with mobility device securement or with boarding and off boarding safety policy and procedures. We continue to monitor fixed route compliance and report deficiencies.

After more than 16 months of advocacy efforts, the bus/streetcar line transfer station is now accessible.

Case Example: Client who regularly uses the Canal Streetcar line and transfers to the City Park Bus line complained that the transfer station was inaccessible. After 16 months of advocacy, the transfer station now complies with ADA standards.

2. Objective: Pursue corridors of accessibility through the French Quarter.

Result: The uptown portion of the Accessible Corridors project has been advanced to 60 % completion of project street and sidewalk assessment. Mapping and analysis of needed infrastructure repairs and improvements along corridor route completed by consulting contractor.

Have met with the Vieux Carre Commission on two occasions to provide input on design details of curb ramps, their color, surface finish and truncated dome panel color. Commission approved template will be used along French Quarter corridors. Project is to be completed along 4 streets by 2013.

Vieux Carre Commission adopted curb ramp design, color, surface finish that will serve as template for current funded 4 corridors but will serve as design used for future FQ sidewalk accessibility improvement.

VC Commission approved wheelchair curb ramp design to serve as template for future sidewalk accessibility improvements AC staff advocated for adopted curb ramp design.

Case Example: Client who made original complaint about inaccessibility of French Quarter has been updated about progress periodically and is satisfied by progress.

3. Objective: Monitor DHH’s request for federal approval to implement an income disregard to allow EDA and ADHC Waiver recipients to qualify for services with income as high as those currently allowed for Louisiana nursing facility residents.

Result: This was a multi-year process of monitoring the efforts of the Louisiana Department of Health and Hospital to secure federal approval to implement an income disregard to allow recipients of the Elderly and Disabled Adult (EDA) Waiver Program and the Adult Day Health Care (ADHC) Waiver Program to qualify for services with incomes as high as those currently allowed for Louisiana nursing facility residents.

Until now, in Louisiana and all other states, there has been an income cliff—once someone was $1 above the limit, no help at all was available unless the individual moved into a nursing facility. The Louisiana Department of Health and Hospitals has changed that. Now those with incomes over the limit can get services too. Louisiana is the first state in the country to receive federal approval for this type of expansion.

Two policies were changed. As a result of the efforts of the P&A, DHH is offering eligibility prospectively and has reviewed applicants denied under the old policy since December 2010.

Case Example: AC’s client, whose income was just $25 over the eligibility limit for the EDA Waiver, is now receiving in-home waiver services.

4. Objective: Negotiate with DHH to expand financial eligibility criteria for two groups of nursing home residents: residents whose income is above what Medicaid pays, but below what they would need to pay as private patients; and residents who need Medicaid coverage to pay Medicare co-payments.

Result: As a result of successful P&A intervention, the goal was met when two policies were changed.

Policy was amended to bar denial of people not eligible at the time of application, but who may become eligible during the period covered by the application, because they continue to incur nursing facility costs.

The second change in policy was the addition of a new Medically Needy category to recognize Medically Needy eligibility for persons in nursing facilities in a Medicare co-insurance period, but with income over the Special Income Level. The previous policy did not allow these individuals to be eligible for Medicaid coverage. The amended policy allows these individuals to qualify for Medicaid through spend-down. They are no longer liable for the balance of their coinsurance after meeting the spend-down.

Case Example: AC client, who had been denied Medicaid coverage for nursing home care because of assets at application, became eligible for coverage after having “spent down” certain assets during the application period.

5. Objective: Monitor and provide input into new Medicaid managed care initiatives.

Result: The P & A requested many policy changes in response to draft policies, contracts, and requests for proposals issued by the agency, emergency rule-making, non-emergency rule-making, and advocacy outside of these announced opportunities for input.

Most requested changes have not been made. However, four responsive policy changes have been adopted: clarified the scope of Medicaid coverage for medical equipment, appliances, and supplies, and EPSDT coverage; allowed family members to choose differing managed care plans from each other; and improving the medical necessity standard.

Case Example: We do not have a case example for this initiative in that Louisiana’s Medicaid Managed Care System has not been rolled out yet.

6. Objective: Monitor EPS by: (1) tracking at least three (3) EPS responses to callers who are referred to EPS, or callers who have already been unsuccessful in contacting EPS; and, (2) tracking the outcomes of EPS involvement in at least three (3) of our cases of direct representation or technical assistance.

Result: Time and resources did not permit us to make progress on this objective.

Case Example: N/A

B. Litigation/Class Actions

1. Number of individuals potentially impacted by changes as a result of PAIR litigation/class action efforts50,360
2. Number of individuals named in class actions0

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.

1. Objective: Ensure the Mahalia Jackson Theater for the Performing Arts in New Orleans is compliant with accessibility laws.

Result: Worked with City of New Orleans and additional two defendants, (Arts Center Enterprises (ACE), theater manager, and Louisiana Philharmonic Orchestra (LPO), theater tenant) to ensure appropriate modifications to the theater and appropriate ticketing policies. We are working toward a settlement agreement and collaborating with the U.S. Department of Justice (USDOJ). The result of the settlement will increase wheelchair spaces in the theater and appropriate ticketing policies.

We have been working with the USDOJ, which has an existing settlement agreement that covers the facility to ensure that the theater is accessible to individuals with disabilities. This involves bringing together various parties to resolve accessibility issues that are not addressed by the suit and which our client does not have standing to raise, (specifically, the accessibility of a sound platform that would be at issue if a production employee needed wheelchair access.)

Case Example: Client who uses wheelchair wanted to attend symphony performance but was told only accessible seating was “box” seating which is more expensive than general admission. Client was not accommodated with reduction in price. AC sued ACE, City of New Orleans and the LPO. USDOJ intervened. Case is in settlement negotiations.

2. Objective: Ensure that the East Baton Rogue Housing Authority makes reasonable accommodations (including transfers) available to tenants with disabilities by monitoring compliance with the settlement agreement in Keller v. East Baton Rouge Housing Authority (EBRHA).

Result: Enforcement of stipulation of settlement in Keller v. East Baton Rouge Housing Authority.

In FY 2011, sent demand letters on October 6 and December 12 2010 and January 27, 2011. Met with EBRHA staff and their attorney by phone on 4/5/11. Analyzed documents provided in response to letters and at meeting.

EBRHA created a new, largely acceptable reasonable accommodations policy, has changed its policy about offering accessible units to people who need accessible units on the waiting list, and has software to track accommodation requests. Sent demand letter on December 2, noting improvement, but asking for additional steps.

Approximately 3,600 families are currently served by public housing in Baton Rouge.

Case Example: This action was initially brought on behalf of a 62 year old client who wished to transfer from an inaccessible apartment to one that is accessible. The client’s deteriorating health demanded that she use a wheelchair.

2. Objective: Ensure that sidewalks in the City of Mansfield are accessible through monitoring of the settlement agreement in Rankin v. City of Mansfield.

Result: Sidewalks listed in City’s Compliance Plan have been made accessible.

Case Example: This case was brought in response to a complaint by the plaintiff that he could not navigate the sidewalks of the City of Mansfield due to uneven pavement and a clack of curb cuts.

4. Objective: Monitor cuts that DHH may impose on home and community based services and be prepared to challenge any cuts that violate consumers’ rights under the ADA and the Rehabilitation Act to receive services in the most integrated setting.

Result: Filed class action on behalf of 4 named plaintiffs on September 22, 2010. DHH filed motion to dismiss on the ground that they have an effectively working plan for community-based long term care services and that they have made progress at increasing HCBS and decreasing the use of institutions. We filed opposition 11/10/11. We are co-counseling with Steve Gold and have signed co-counseling agreement to bring in AARP Legal Foundation.

Reduction in maximum hours of LT-PCS from 42 to 32 will affect some individuals who are receiving close to 42 hours by placing them at risk of institutionalization for care.

Case Example: Client who was receiving 42 hours of EDA Waiver services was reevaluated and offered 32. This placed the client at risk of institutionalization as this client cannot dress, feed herself or perform basic grooming tasks without aid.

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.

(1.1) Identify and describe priority: To ensure that people with disabilities and seniors receive the medical care, community supports and other public benefits to which they are entitled by law.

(1.2) Identify the need, issue or barrier addressed by this priority: Medicaid and Medicare programs often fail to provide necessary services so that persons with disabilities who choose to do so can reside in home and community-based settings. Persons with disabilities are often denied needed medical services.

(1.3) Identify and describe indicators PAIR used to determine successful outcome of activities pursued under this priority: o Our goal was to represent 150 people in Medicaid matters. We represented 185 individuals in Medicaid matters — denial of eligibility; reduction or termination of services; denial of payment for medially necessary goods and services except for issues related to the Medically Needy and Lock-In Programs. o Our goal was to represent 15 individuals in Medicare issues — denial of eligibility, denial of payments for services; termination of benefits. We met our goal. o Our goal was to monitor cuts that DHH might impose on home- and community-based services. We did so and filed a lawsuit under the ADA challenging these cuts. o Our goal was to monitor and submit comments on the new Medicaid managed care initiatives. We did so.

(1.4) Explain whether pursuing this priority involved collaborative efforts by other entities. If so, describe this collaboration: We collaborated with Attorney Steve Gold on the suit challenging cuts to Medicaid. We collaborated with Attorney David Williams of the Southeast Louisiana Legal Services Corporation on our comments regarding the proposed managed care system.

(1.5) Provide the number of cases handled under this priority. Indicate how many of these, if any, were class actions: The number of cases we handled under this priority was 185. One of these was a class action lawsuit.

(1.6) Provide at least one case summary that demonstrates the impact of the priority: A 64 year old woman with chronic obstructive pulmonary disease, emphysema, arthritis and a heart condition called the Advocacy Center because a Department of Health and Hospitals (DHH) policy prohibited her from being eligible for both physician ordered in-home hospice services and in-home personal care services under the Long Term Personal Care Services Program (LT-PCS). An Advocacy Center attorney contacted DHH legal counsel regarding the violation of the client’s rights. The attorney then submitted a demand letter. As a result, DHH changed the policy. Our client received both services and remained at home. She passed away knowing that her willingness to fight for her rights would allow others similarly situated to be able to receive both in-home LT-PCS and hospice services.

(2.1) Identify and describe priority: Ensure the rights of people living in Louisiana psychiatric hospitals, developmental centers, adult residential facilities, and child residential facilities through individual advocacy.

(2.2) Identify the need, issue or barrier addressed by this priority: People who live in congregate settings are vulnerable to abuse, neglect and denial of rights.

(2.3) Identify and describe indicators PAIR used to determine successful outcome of activities pursued under this priority: o Our goal was to monitor conditions in twenty-four facilities. We met our goal. o Our goal was to represent 20 individuals in rights violations. We represented 11 individuals in rights violations (privacy; medication; property; discharges) and in unlawful use of restraint and seclusion. o Our goal was to ensure the rights of people living in Louisiana institutions through investigations of five situations that appear to be egregious, systemic or that have widespread potential impact; that involve death reports; that involve death or serious injury attributable to restraint and seclusion, the failure of facilities to follow regulations on restraint and seclusion, and the misuse or excessive use of chemical restraint. We met our goal.

(2.4) Explain whether pursuing this priority involved collaborative efforts by other entities. If so, describe this collaboration: We did not collaborate on this priority.

(2.5) Provide the number of cases handled under this priority. Indicate how many of these, if any, were class actions: We handled eleven cases under this priority.

(2.6) Provide at least one case summary that demonstrates the impact of the priority: A man with paraplegia contacted the AC seeking assistance with: 1) filing a complaint with DHH against a nursing home in Lafayette because of the conditions of the hospital and the problems he has had with staff; 2) getting transferred into another facility that can provide more adequate medical treatment to meet his needs. The client was advised on how to file a complaint with DHH and how to find another facility. We also researched his complaints regarding this particular home and have flagged it as a facility to watch. His records were procured and reviewed. It appeared possible that client’s bedsores had not been treated appropriately. Client was provided with his record and advised to contact a civil attorney.

(3.1) Identify and describe priority: Ensure that people with disabilities and seniors are enabled and empowered to exercise their right to self-determination to the fullest extent of the law.

(3.2) Identify the need, issue or barrier addressed by this priority: People with disabilities are often deemed to be incompetent to make choices.

(3.3) Identify and describe indicators PAIR used to determine successful outcome of activities pursued under this priority: o Our goal was to represent 15 people in matters of self-determination. We represented 23 people in matters concerning the execution and revocation of Powers Of Attorney, living wills, and representative payee issues related to representation of clients on other issues and on Interdiction (meritorious revocations, defenses, requests for court review of curator or placement, move from full to limited and on other limitations on decision-making. o Our goal was to monitor Elderly Protective Services (EPS). We monitored one EPS case and determined that the EPS and Adult Protective Services (APS) systems need a complete overhaul. We are looking into ways to address the inadequacy of the adult and elderly protective services systems in our state.

(3.4) Explain whether pursuing this priority involved collaborative efforts by other entities. If so, describe this collaboration: We did not collaborate on this priority.

(3.5) Provide the number of cases handled under this priority. Indicate how many of these, if any, were class actions: We handled twenty-three cases under this priority.

(3.6) Provide at least one case summary that demonstrates the impact of the priority: Mother of a son with quadriplegia contacted the Advocacy Center. The son, who was unable to leave the house without the aid of an ambulance, needed a Power of Attorney. The AC attorney met with son who confirmed that he wanted to give his mother a POA so that she could handle his affairs. Of particular importance was that without a POA, his mother could not get client a copy of his ID which he needed so that his mother could qualify him for government benefits he desperately needed. A POA was executed and mother was finally able to apply for benefits on behalf of her son.

(4.1) Identify and describe priority: Ensure that people with disabilities and seniors have access to government services, private businesses and other public accommodations and housing.

(4.2) Identify the need, issue or barrier addressed by this priority: People with disabilities often face discriminatory practices by both public and private entities that deny them access to services and full use of buildings.

(4.3) Identify and describe indicators PAIR used to determine successful outcome of activities pursued under this priority: o Our goal was to represent 25 individuals in access issues. We represented 35 individuals in cases where the issue was egregious, involved a critical need, had widespread impact, or involved access to government programs and services; access to places of public accommodation; housing. o Our goal was to ensure that fixed route and paratransit transportation in New Orleans is compliant with the ADA. We met our goal, (see systems report.) o Our goal was to pursue corridors of accessibility through the French Quarter. We met our goal, (see systems advocacy report.) o Our goal was to ensure the Mahalia Jackson Theater for the Performing Arts in New Orleans is compliant with accessibility laws. We met our goal, (see litigation report.) o Our goal was to ensure that the athletic facilities at Southern University are compliant with accessibility laws. Litigation in this matter is progressing. o Our goal was to ensure that the East Baton Rouge Housing Authority makes reasonable accommodations (including transfers) available to tenants with disabilities by monitoring compliance with the settlement agreement in Keller v. East Baton Rouge Housing Authority. We met our goal, (see litigation report.) o Our goal was to ensure that sidewalks in the City of Mansfield are accessible through monitoring of the settlement agreement in Rankin v. City of Mansfield. We met our goal, (see litigation report.) o Our goal was to ensure that the City of Lafayette’s paratransit system complies with the ADA. We examined records from the paratransit service that did not show major problems. Our client has not as yet produced records that show individual problems, nor have other community members we reached out to. We continue to monitor. We filed a complaint with the FTA regarding the transit entity’s failure to implement an ADA complaint process. The FTA has issued a corrective action letter to the local government and the matter is ongoing.

(4.4) Explain whether pursuing this priority involved collaborative efforts by other entities. If so, describe this collaboration: We collaborated with the U.S. Department of Justice on the Mahalia Jackson case.

(4.5) Provide the number of cases handled under this priority. Indicate how many of these, if any, were class actions: We handled thirty-five cases under this priority.

(4.6) Provide at least one case summary that demonstrates the impact of the priority: Our client, who is elderly, has several health issues, including renal failure that requires dialysis treatment. Due to measures that had to be taken when she had a stroke several years ago, she also has a tracheostomy. She lived in a nursing home that provided her with dialysis treatment. She did not like the nursing home and expected to return to her home once its post-Katrina renovation was completed. In 2008, shortly before Hurricane Gustav, our client had to be hospitalized. She was evacuated prior to Gustav, and returned to the hospital afterwards. Not long after, she was cleared for release from the hospital. By this time, however, she had lost her nursing home bed. Renovations at her children’s home were complete, though, and they wanted to take her in. She could not, however, find a dialysis treatment center that would take a patient with a tracheostomy, nor could she find a nursing home that would provide dialysis for a patient with tracheostomy. AC intervened and contacted an outpatient dialysis provider housed at the hospital where our client was now living (the dialysis provider contracted with the hospital and was not the same entity). In response, the dialysis provider worked with the hospital to ensure its staff were trained to suction our client’s trach if necessary, and our client was able to move home.

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.

(1.1) Statement of Priority: Ensure that people with disabilities and seniors have access to government services, private businesses and other public accommodations and housing.

(1.2) Need Addressed: People with disabilities often face discriminatory practices by both public and private entities that deny them access to services and full use of buildings

(1.3) Description of Activities:

• Represent 25 individuals only where the issue is egregious, involves a critical need, has widespread impact, or involves access to government programs and services, access to places of public accommodation or housing

• Provide training on access issues to at least five groups

• Address systemic and policy issues through membership on the New Orleans Mayor’s Advisory Council on Disability Issues

• Ensure that fixed route and paratransit transportation in New Orleans is compliant with the ADA by periodically testing usage of the RTA and fixed route systems, by attending quarterly RTA Board meetings, and through participation on the RTA Special Transit Services Committee.

• Pursue corridors of accessibility through the French Quarter.

• Ensure the Mahalia Jackson Theater for the Performing Arts in New Orleans is compliant with accessibility laws via pursuit of Matthews case.

• Ensure that the athletic facilities at Southern University are complaint with accessibility laws via pursuit of Eames case.

• Ensure that sidewalks in the City of Mansfield are accessible through monitoring of the settlement agreement in Rankin v. City of Mansfield.

(2.1) Statement of Priority: Insure that people with disabilities can live in the most integrated environment appropriate to their needs

(2.2) Need Addressed: People with disabilities continue to be discriminated against through the provision of services that are needlessly restrictive.

(2.3) Description of Activities:

• Train at least five groups about rights under the ADA and other state and federal laws that guarantee rights to people with disabilities

• Ensure that people with disabilities are able to live as independently as possible by advocating for increased hours under the LT-PCS program via the Pitts lawsuit.

(3.1) Statement of Priority: Ensure that people with disabilities and seniors receive the medical care, community supports and other public benefits to which they are entitled by law.

(3.2) Need Addressed: Medicaid and Medicare programs often fail to provide necessary services so that persons with disabilities who choose to do so can reside in home and community-based settings. Persons with disabilities are often denied needed medical services.

(3.3) Description of Activities:

• Represent 125 people in matters related to denial of Medicaid eligibility, reduction or termination of Home and Community Based Services (excluding health and safety or failure to cooperate) and issues around Managed Care.

• Train at least five groups on issues related to Medicaid services

• Address policy issues through membership on the Home and Community Based Services Re-Design Group

• Monitor cuts that DHH may impose on home-based and community-based services and be prepared to challenge any cuts that violate consumers’ rights under the ADA and the Rehabilitation Act to receive services in the most integrated setting.

• Monitor and provide input into the implementation of the new Medicaid managed care initiative. Negotiate and take other appropriate action.

• Continue to monitor the Division of Administrative Law (DAL) and obtain procedures that grant reasonable accommodations, are compliant with federal Medicaid guidance, and deal appropriately with unrepresented appellants. Collaborate with other issue groups, as appropriate.

• Develop and begin to implement a plan to ensure that DHH adheres to a medical improvement standard so that benefits will not be reduced or terminated unless there is evidence that the individual has actually improved, (across the board cuts are excluded).

• Do preliminary research into a possible challenge of Medicaid’s physician visit limitation.

• Challenge Medicaid’s failure to provide recipients with notice of payment denials and prior authorization denials.

(4.1) Statement of Priority: Ensure the rights of people living in select Louisiana psychiatric hospitals, developmental centers, adult residential facilities, and other residential facilities by providing high quality individual advocacy on issues that stand as barriers to integration in the community, full enjoyment of human and civil rights, and to the development of the individual’s full potential.

(4.2) Need Addressed: People who live in congregate settings are vulnerable to abuse, neglect and denial or rights

(4.3) Description of Activities:

• Represent 50 people in legal and civil rights violations, (privacy; medication; property; discharges), unlawful use of restraint and seclusion, denial of, or failure to provide, necessary and appropriate services, programs and benefits, and in involuntary discharges from ICF/MR facilities and nursing homes.

(5.1) Statement of Priority: Ensure that people with disabilities and seniors are enabled and empowered to exercise their right to self-determination to the fullest extent of the law.

(5.2) Need Addressed: People with disabilities are often deemed to be incompetent to make choices

(5.3) Description of Activities:

• Represent 15 people in POAs, living wills, representative payee issues related to representation of clients on other issues.

• Train five groups in matters related to legal status

• Determine the efficacy of EPS and APS by a concerted systems advocacy approach.

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 and Expended

The primary source of funding for the PAIR program comes from the federal Section 509 grant, including carryover from the prior year as follows:

Sources of funding amount received and spent:

Source of Funding Amount Received Amount Spent Federal Funds (includes carryover) $ 254,637 $ 254,637 State Funds 0 0 Program Income $ 10,254 $ 10,254 Private 0 0 All other funds $ 24,540 $ 24,540 Total $ 289,431 $ 289,431

B. Budget for the fiscal year covered by this report

The chart below provides a breakdown of the PAIR program budget for FY 2011, the period covered in this report. In general, the Advocacy Center’s budget is driven by staff hours as charged to its various programs. When Administrative and Support staff salaries are not charged directly, they are allocated among programs in a pro-rata share of total agency staff hours worked.

Category Budget FY 2011 Wages & Salaries $ 182,185.92 Fringe Benefits $ 44,200.20 Travel $ 5,381.88 Bonding/Insurance $ 554.04 Materials/Supplies $ 3,333.00 Postage $ 1,803.00 Duplicating $ 1,467.00 Rent $ 15,567.96 Telephone/Cell Phone/Internet $ 4,486.80 Legal Services $ 3,000.00 Services & Service Contracts $ 5,147.04 Equipment $ 945.00 Indirect Costs $ 0 Miscellaneous $ 5,726.04 TOTAL $ 273,797.88

C. Description of PAIR staff (duties and person-years)

The majority of time allotted to PAIR services in FY 2011 was spent providing representation to individual clients, systems advocacy, impact litigation, outreach and training and other agency support activities, including intake and I&R for those clients whose issues did not fall under case selection priorities.

The Advocacy Center organizes its professional staff by legal issues groups, whose members specialize in areas of law across multiple programs. No staff members are assigned solely to the PAIR program. Rather, of the full-time professional staff, each person spends a percentage of his time serving PAIR clients. Established issue groups which provide services to PAIR include: Institutional Rights, Financial Entitlements, Self Determination, and Access. Each group’s individual representation services parallel one of the PAIR program’s priorities, already described in this report.

The annual plan for PAIR estimates how much of the time each individual staff member will spend providing services to PAIR eligible clients. Staff time is then budgeted accordingly. These estimates are based upon prior year records and are adjusted to reflect expected increases or decreases resulting from changes to case selection priorities or new initiatives. On a daily basis, staff members record how their time was spent, allotting it to the programs for which their services were performed. Thus, all time spent providing individual representation to PAIR eligible clients is allotted to PAIR. The information is reported bi-weekly, and is compiled monthly to monitor how closely actual time spent tracks staff time budgeted. If necessary, adjustments are made during the year to insure that the hours budgeted under PAIR are not used at a rate that is significantly higher or lower than anticipated.

Professional staff include the following positions: Compliance Specialist, Systems Advocacy Specialist, Legislative Support Specialist, Intake Coordinator, Intern, Paralegals, Staff Attorneys, Managing Attorneys, Director of Litigation, Director of Legal Services, Executive Director, and Director of Policy & Planning. Their duties include planning, managing, supervising and performing outreach, training, individual client representation, systems advocacy, and litigation on behalf of PAIR clients. Administrative Support or Clerical staff include the following positions: Receptionists, Administrative Support Specialists, Executive Assistant, Chief Financial Officer, Systems Administrator, Chief Information Officer and Intake Specialists.

The Person-Year chart below was prepared by combining staff time for all employees who performed services under PAIR during the fiscal year. Positions filled for any fraction of the year are expressed as full-time equivalents. Positions filled throughout the year are expressed as person-years.

PAIR Staff in Person-Years: Type of Position Full-Time % of Year Person-Years Equivalent Position Filled Professional Full-Time 2.6171 100% 18 Professional Part-Time 0.8127 100% 3 Professional Vacant 0 0 0 Clerical Full-Time 0.1283 100% 6 Clerical Part-Time 0.3275 100% 3 Clerical Vacant 0 0 0 TOTALS 3.8856 100% 30

D. Involvement with Advisory Board

Not applicable

E. Grievances filed under the grievance procedure

The Advocacy Center had one grievance filed for this fiscal year. Caller contacted Advocacy Center in May, 2010 to secure legal assistance with a denial of SSA/SSI disability benefits. Caller was directed to speak to the Director of our Protection & Advocacy for Beneficiaries of Social Security (PABSS) Program and the Managing Attorney who oversees all financial entitlement cases. Caller was explained that his issue did not fall within AC priorities and therefore, AC could not take his case. The Managing Attorney wrote a non-engagement letter declining his case, giving him referrals to the Pro Bono Project, New Orleans Legal Assistance Corporation (NOLAC) and Louisiana Bar Association. Caller was also informed of the Advocacy Center’s grievance procedure and was given a written copy of our policy. Caller filed a grievance for denial of services with the Executive Director of the Advocacy Center. After reviewing all information, the Executive Director issued a decision upholding the determination of AC staff and reported the grievance to the Advocacy Center’s Governing Board. Caller, still dissatisfied, filed a complaint with the EEOC against the Executive Director, PABSS Program Director and Managing Attorney of the Advocacy Center. After careful review of all information provided, the EEOC’s final determination was that the caller’s complaint held no merit.

F. 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.

The CAP is part of the P&A. The Long Term Care Ombudsman Program, while not a part of the Protection and Advocacy System, has a formal relationship with one of the attorneys on our staff who provides legal backup to the ombudsmen, statewide.

Certification

Signed?Yes
Signed ByLois V Simpson
TitleExecutive Director
Signed Date12/22/2011