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

Alaska (DISABILITY LAW CENTER OF ALASKA) - H240A120002 - FY2012

General Information

Designated Agency Identification

NameDisability Law Center of Alaska
Address3330 Arctic Blvd. 103
Address Line 2
CityAnchorage
StateAlaska
Zip Code99503
E-mail Addressakpa@dlcak.org
Website Addresshttp://www.dlcak.org
Phone907-565-1002
TTY 907-565-1002
Toll-free Phone800-478-1234
Toll-free TTY800-478-1234
Fax907-565-1000
Name of P&A Executive DirectorDavid C. Fleurant
Name of PAIR Director/CoordinatorDavid C. Fleurant
Person to contact regarding reportDavid C. Fleurant
Contact Person phone907-565-1002
Ext.

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 areas318
2. Individuals receiving I&R outside PAIR priority areas334
3. Total individuals receiving I&R (lines A1 + A2)652

B. Training Activities

1. Number of trainings presented by PAIR staff16
2. Number of individuals who attended training (approximate)300

As a result of the Alaska P&A’s outreach in FY12, once again we reached about 300 people with information about their rights and most had the opportunity to meet one-on-one with staff to discuss legal concerns associated with their disabilities. Training topics included: benefits available for transitioning individuals (ages 17-22), strategies for advocacy and access to workplace accommodations and the Ticket to Work and other work incentives, prevention/detection of abuse and neglect; housing rights, special education rights, social security benefits and the administrative appeals process.

As with the last few years, several SOAR (SSI/SSDI Outreach, Access and Recovery) trainings were conducted as well. This is a project the Alaska P&A is coordinating with Federal, State, Municipal, and private providers to facilitate the SSI process for the homeless. Through SOAR, providers are trained to properly complete SSI/SSDI applications, which are then flagged and prioritized by the state disability determination service. The Social Security field office designates staff to be available to assist providers who may have questions or need assistance while the application is being completed. By training providers to help their clients through this process-many; many more individuals are receiving much-needed benefits more quickly than if they were going through the applications on their own.

C. Information Disseminated to the Public

1. Radio and TV appearances by PAIR staff0
2. Newspaper/magazine/journal articles0
3. PSAs/videos aired0
4. Hits on the PAIR/P&A website64,609
5. Publications/booklets/brochures disseminated13,200
6. Other (specify separately)0

Narrative

Popular publications created by the Alaska P&A include: *Social Security Disability Handbook (with a focus on the appeal process once a person has been denied benefits) *Applying for Social Security Benefits in Alaska (focuses on the initial application for benefits and gives helpful suggestions in moving through the process) *Prisoner Rights Handbook (Often requested by people with disabilities who are incarcerated or by their family members) And also: Educating Students with Traumatic Brain Injury, Your Mental Health Rights in Alaska, Guardianship in Alaska, and Rights of Persons with Developmental Disabilities.

The huge jump in the amount of publications disseminated (normally closer to 1,200) is attributable to the P&A acquiring the Client Assistance Program (CAP) in FY12. As a part of that transition (from an operating agency that had held the contract for many years) the P&A printed and distributed 12,000 brochures to various State and Tribal Vocational Rehabilitation agencies and also the Independent Living Centers (ILC’s). We started with a press run of 3000, but the demand was so great we went back to the printer several more times to satisfy the need.

Having the CAP under the same roof with the rest of the P&A programs benefits clients with a range of disabilities. Often prospective clients will call with a problem in one issue area, but through investigating the situation we find they are eligible for, and can use assistance in, many other areas.

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)71
2. Additional individuals served during the year50
3. Total individuals served (lines A1 + A2)121
4. Individuals w. more than 1 case opened/closed during the FY. (Do not add this number to total on line A3 above.)1

B. Individuals served as of September 30

Carryover to next FY may not exceed total on line II. A.3 above 68

C. Problem Areas/Complaints of Individuals Served

1. Architectural accessibility0
2. Employment11
3. Program access1
4. Housing7
5. Government benefits/services72
6. Transportation2
7. Education0
8. Assistive technology0
9. Voting0
10. Health care11
11. Insurance1
12. Non-government services0
13. Privacy rights0
14. Access to records0
15. Abuse8
16. Neglect5
17. Other4

D. Reasons for Closing Individual Case Files

1. Issues resolved partially or completely in individual favor20
2. Other representation found0
3. Individual withdrew complaint1
4. Appeals unsuccessful8
5. PAIR Services not needed due to individual's death, relocation etc.2
6. PAIR withdrew from case1
7. PAIR unable to take case because of lack of resources4
8. Individual case lacks legal merit16
9. Other2

Please explain

1 client dropped out of contact with the P&A 1 client had legal issues that turned out not to be related to their disability

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-advocacy2
2. Short-term assistance19
3. Investigation/monitoring13
4. Negotiation3
5. Mediation/alternative dispute resolution2
6. Administrative hearings13
7. Litigation (including class actions)2
8. Systemic/policy activities0

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 - 5988
4. 60 - 6415
5. 65 and over17

B. Gender of Individuals Served

Multiple responses not permitted.

1. Females52
2. Males69

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 Native32
3. Asian4
4. Black or African American6
5. Native Hawaiian or Other Pacific Islander0
6. White70
7. Two or more races0
8. Race/ethnicity unknown6

D. Living Arrangements of Individuals Served

Multiple responses not permitted.

1. Independent74
2. Parental or other family home15
3. Community residential home5
4. Foster care0
5. Nursing home5
6. Public institutional living arrangement1
7. Private institutional living arrangement0
8. Jail/prison/detention center7
9. Homeless7
10. Other living arrangements4
11. Living arrangements not known3

E. Primary Disability of Individuals Served

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

1. Blind/visual impairment2
2. Deaf/hard of hearing4
3. Deaf-blind0
4. Orthopedic impairment45
5. Mental illness2
6. Substance abuse0
7. Mental retardation0
8. Learning disability1
9. Neurological impairment13
10. Respiratory impairment4
11. Heart/other circulatory impairment9
12. Muscular/skeletal impairment15
13. Speech impairment1
14. AIDS/HIV2
15. Traumatic brain injury3
16. Other disability20

Part IV. Systemic Activities and Litigation

A. Systemic Activities

1. Number of policies/practices changed as a result of non-litigation systemic activities1

2. Number of individuals potentially impacted by policy changes600

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.

In FY12 the Alaska P&A worked in collaboration with State agencies and stakeholder groups to revise the grievance procedure available to patients undergoing treatment at a public or private mental health evaluation facility or hospital mental health unit. The objective of this collaborative effort is to develop a grievance process that covers all state and private mental health facilities or hospital mental health units licensed in the state. This issue is relevant, of course, to those with mental illness but will also benefit people with any type of disability who are in crisis and in need of a mental health evaluation.

The working group believes that because of the exceptional circumstances under which such patients are admitted and treated, procedural due process requires special safeguards. The culmination of these efforts has been a bill introduced to the Alaska Legislature that would mandate the following: ? Detailed complaint forms; ? Written answers by an impartial body within 5 days; ? Three levels of appeal; ? Response to urgent grievances within 24 hours; ? Easy access to grievance forms; ? A secure complaint box in which to deposit the grievance forms. (The contents of the complaint box are to be read each day and the original and a copy of the form must be kept in the patient record. ? Facilities and units must file quarterly reports of the number and type of grievance and the resolution, including litigation. A bill was introduced at the beginning of the 2011 legislative session, moved to hearing in 2012 and remains now in committee.

In a second systemic issue, the Alaska P&A worked with the State of Alaska’s Fetal Alcohol Spectrum Disorders (FASD) Partnership in drafting language for a bill that would make FASD and brain injury mitigating factors in criminal sentencing. The P&A’s role involved researching current mitigating factors in Alaska and in other states as well as research on the intersection of FASD/brain injury and criminal justice.

The collaboration between the Partnership, Senator Meyers, and the Alaska P&A was successful in its effort to pass Senate Bill 151, establishing FASD as a mitigating factor in criminal sentencing. The fact that the bill passed both the Senate and the House in the second half of the legislative session is a testament both to the importance of the bill and the hard work of the collaborators, particularly Senator Meyer and his staff.

B. Litigation/Class Actions

1. Number of individuals potentially impacted by changes as a result of PAIR litigation/class action efforts1,300
2. Number of individuals named in class actions2

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.

Although other grants are the primary source of funding for activity associated with the litigation discussed below, the cases are notable here because the P&A does serve individuals who commonly have several kinds of disabilities, some of which make them PAIR eligible.

Under this objective the Alaska P&A is representing 2 named plaintiffs in a class action, i.e. a lawsuit brought by one or more people on behalf of a large group of others who have a common interest. The class in this case is composed of individuals with a range of disabilities, all of whom had a particular representative payee.

Beginning in 2009/10, the P&A began to receive many complaints about a specific representative payee. (Commonly referred to as a “rep.” payee for short, this is a person who provides financial management of Social Security and SSI payments for people with disabilities who are not capable of managing those funds. Payees are appointed by the Social Security Administration.) The calls we received were coming in both from this rep. payee’s clients and from other service providers who were passing on their concern about possible mishandling of Social Security money by this same payee.

There are steps available to people who have payees to make a complaint and even to request a change of representative payees, and it’s not uncommon for people to be unhappy having a rep. payee at all. It was the volume of these complaints against one woman that raised our concerns. Those concerns turned out to be justified.

It appears that this payee was trying to handle the funds of as many as 300 social security beneficiaries simultaneously. (Although that number is hard to pin down as she confessed to shredding all of her records.) At some point, she just stopped being available to her clients. As rents and utility bills went unpaid, through no fault of their own, her clients were at risk of becoming homeless—a dire fate for anyone, but especially for this vulnerable population, compounded by the very real threat posed by the sometimes harsh weather in Alaska.

Ultimately, Social Security terminated the payee’s status and found new payees for these beneficiaries, but no steps had been taken to recover their misused funds. The Alaska P&A initially requested on behalf of these individuals that the former representative payee pay damages of $500 per violation of state law (in other words, $500 per person that she represented). Ultimately, the matter was settled with the woman agreeing to pay $40,000 to be spread amongst the affected individuals.

The P&A is now in the process of reaching out in every way possible to find members of this class. The task, of course, is more difficult than it would otherwise be since the records were destroyed by the payee. But for the people we have tracked down, this settlement is very important—not only because every penny is vital when your sole income is Social Security benefits, but also because they feel vindicated that the P&A heard, cared and acted on their behalf.

In a separate issue, the Alaska P&A filed on its own behalf to challenge the Department of Health and Social Services’ practice of allowing people with disabilities to be held in jails or hospitals for too long once an ex parte order for a psychiatric evaluation has been issued. The Alaska P&A found that some individuals were in jail up to 6 days with no care or treatment while they waited to be transported. The suit requested that evaluations be performed in the nearest community available to the individual. The P&A also sued the state psychiatric hospital for failing to accept individuals with mental illness up to its licensed capacity, creating unnecessary delays in individuals being able to obtain evaluations. While the court deliberated, the State of Alaska agreed to make alternative arrangements for individuals who do not arrive at the evaluation facility within 24 hours from the time they are taken into custody. A temporary restraining order was also issued that requires the State to deliver individuals notice of their rights upon detention. Discovery as to the merits of the case is ongoing.

As a result of the judge’s ruling that individuals be informed of their rights upon initial detention, the Alaska P&A, along with other stakeholders—the State, Alaska Court System and Public Defender—created a new court form to be used to inform individuals of their rights upon detention for an involuntary commitment. This was an intensive, collaborative process that was well worth the effort to preserve the rights of people with disabilities in the moment at which they can be the most vulnerable. The outcome was immediately beneficial to people with disabilities that are in crisis.

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.

DISABILITY LAW CENTER OF ALASKA FY2012 PAIR PRIORITIES, GOALS, OUTCOME INDICATORS

PRIORITY: ABUSE AND NEGLECT GOAL A: To investigate allegations of abuse (including the use of seclusion and restraint), neglect, and exploitation of individuals with disabilities. ISSUE: Individuals with disabilities have a right to be free from abuse and neglect.

Outcome Indicators: A.1. Investigate 3 reports of abuse and neglect of individuals with disabilities; A.2. Assess whether, in at least 3 investigations, all federal, state, and local agencies charged with the responsibility of investigating complaints of abuse and neglect of individuals with disabilities conduct their investigations in a timely, thorough and objective manner; A.3. Advocate for full recognition of DLC’s access authority by State Certification and Licensing and the Centers for Medicare and Medicaid Services (CMS) with regard to investigations and surveys conducted under the auspices of CMS, and CMS’s reporting to the DLC all restraint related deaths that occur in hospitals, including psychiatric facilities (2 year priority); A.4. Establish and maintain contact with residents of assisted living homes, psychiatric facilities (adult and child), prisons, jails, and in Division of Juvenile Justice facilities, through at least 5 facility visits;

Strategic/Resource Guidance: Complaints alleging the following abuse will be prioritized: suspicious death, seclusion & restraint, eminent threat of harm, sexual misconduct. Complaints originating in facilities with repeated complaints of abuse and neglect will be prioritized. If a complaint of abuse or neglect is being investigated by the police, DLC may delay its own investigation pending the outcome of that investigation.

Collaboration: The Alaska P&A has sought to develop and maintain cooperative, complimentary relationships with state agencies that have similar mandates and authority to investigate allegations of abuse or neglect and other complaints filed by or on behalf of individuals with disabilities. In Alaska, those agencies include, but are not limited to: Health Facilities Certification & Licensing (licensing and certifying health facilities as well as assisted living homes); the Office of the Long-Term Care Ombudsman; Adult Protective Services; Medicaid Fraud Unit; and others such as the Alaska State Troopers and the Anchorage Police Department.

In the past year, the P&A has enjoyed increased cooperation and the sharing of information from and with Certification & Licensing, the Office of the Long Term Care Ombudsman and the Anchorage Police Department. While the Centers for Medicare/Medicaid continue to deny the P&A access to their documentation that is not public information, State Certification & Licensing staff have been willing to discuss their process and findings with P&A staff, and allow access to those documents that are related to State vs. Federal activities. Information exchange and access to documentation has also increased with the Office of the Long Term Care Ombudsman. The P&A continues to receive written reports from law enforcement and this past year P&A staff have also been invited to observe investigative interviews when there has been overlapping jurisdiction.

Number of Cases: Under the heading of Abuse and Neglect, the P&A worked on 46 cases or projects in FY12 including monitoring visits, investigations and individual advocacy.

Case Summary: After receiving complaints of abuse and neglect of residents at Providence Seward Mountain Haven Nursing facility, the Alaska P&A initiated an investigation into the facility under its access authority. Through its investigation, the P&A found the facility had been plagued by problems which included resident falls, elopement, and improper medicine management. Investigations of the facility undertaken by Certification and Licensing also uncovered serious problems placing residents in harmful situations. The nursing facility was cooperative and the P&A worked with them to help improve their operations and resident safety. At a follow-up visit to the facility, the P&A found that numerous safeguards and policy changes had been implemented so as to decrease falls, increase resident overall safety, create better supervision of residents, and to increase effective communication between staff.

PRIORITY: OUTREACH GOAL B: To provide outreach to unserved/underserved individuals with disabilities in Alaska. ISSUE: Individuals with disabilities who are unaware of their rights can neither exercise those rights, nor protect themselves from rights abuses.

Outcome Indicators: B.1. To conduct at least 12 monthly outreach/intake visits at the Veterans Administration’s Comprehensive Homeless Center; B.2. To conduct 5 trainings statewide regarding government benefits available for individuals ages 17-22 who are transitioning from school, specifically targeting individuals in rural areas with traumatic brain injury; B.3. To disseminate information on the housing rights of Alaskans with disabilities through 4 outreach/intake events and via publications on housing rights; B.4 To conduct 8 trainings statewide on social security benefits and the administrative appeals process; B.5. To conduct at 5 statewide trainings regarding strategies for advocacy and access to workplace accommodations and the Ticket to Work and other work incentives; B.6. Conduct six (6) trainings on special education law, including at least three (3) in rural locations. These trainings will emphasize substantive rights, procedural safeguards and techniques for effective self-advocacy; B.7. Disseminate to 100 rural clinics information on education rights and appropriate educational programming for students with traumatic brain injury.

Strategic/Resource Guidance: Outreach activities may be suspended when caseloads involving direct legal advocacy exceed manageable resource levels.

Collaboration: PAIR, PAIMI and PADD programs work together to conduct outreach to unserved/underserved populations. Such collaboration helps defray the costs of travel in Alaska. Staff also collaborates with other state and local agencies in outreach efforts to the homeless to secure for them any necessary legal assistance.

Number of Cases: There are no specific clients/cases to record under this priority, but specific outcomes for each indicator are listed below.

Case Summary: B.1. The Alaska P&A sets aside time to make monthly visits to the Veterans Administration’s Comprehensive Homeless Center (aka: the “VA Domiciliary” or “the Dom”). The P&A’s contact at the Dom works closely with their residents and calls to let us know if there will be anyone who wants to meet with us at the designated time. If nobody is on the schedule, we will forego that month’s visit. In FY12 we visited 3 times. Most intakes at the Dom involve providing information and referral with an offer of more assistance if the person does not find success in following the information and referral provided. Most questions involve Social Security disability benefits.

Relevant to outreach to veterans with disabilities, the Alaska P&A also participated in 1 event geared specifically toward providing services and information to homeless veterans in Anchorage. At this event, which staff from the P&A attends each year, we provided information and referral regarding disability-related questions. The P&A also has a variety of publications available for individuals to take with them. Additionally, the P&A entered its fifth year with the SOAR (SSI/SSDI Outreach, Access & Recovery) Project which collaborates with care coordinating agencies throughout Alaska to train care coordinators how to assist homeless individuals apply for Social Security benefits.

B.2. During the last year, staff from the Alaska P&A traveled throughout the state and did conduct 5 trainings on benefits available for transitioning individuals, ages 17-22, specifically targeting individuals in rural areas with traumatic brain injury. Trainings took place in Kodiak, Anchorage, Fairbanks, Juneau, and Bethel.

B.3. The Alaska P&A disseminated information on the housing rights of Alaskans with disabilities through 4 outreach/intake events in Anchorage, Kodiak, Fairbanks & Juneau.

B.4. The P&A did conduct 8 trainings statewide on social security benefits and the administrative appeals process. This included events in Kodiak, Anchorage, Fairbanks, Juneau, and Bethel.

B.5. The P&A did conduct at 5 trainings regarding workplace accommodations and the Ticket to Work program. This included events in Kodiak, Anchorage, Fairbanks, Juneau, and Bethel.

B.6. The P&A did conduct six 6 trainings on special education law including events in Anchorage, Juneau, the Matanuska-Susitna Valley, Fairbanks.

B.7. With direct-service priorities taking priority, this goal was not met.

PRIORITY: HOUSING GOAL C: To advocate on behalf of individuals with disabilities for housing and to prevent homelessness. ISSUE: Being part of the community and living as independently as possible are among the most important values and goals shared by people with disabilities, their families, friends, and advocates. A home of one’s own — either rented or owned -- is the cornerstone of independence for people with disabilities. However, across the nation, individuals with disabilities face a crisis in the availability of decent, safe, affordable, and accessible housing.

Outcome Indicators: C.1. To advocate on behalf of 2 individuals with disabilities who have complaints of Fair Housing Act and other housing rights violations related to the disability, or require assistance in requesting a reasonable accommodation.

Strategic/Resource Guidance: DLC will prioritize assisting individuals in institutions at risk of losing their community-based housing as a result of institutionalization, but not incarceration. DLC will assist individuals requesting reasonable accommodations in housing as short term assistance to try to ensure better outcomes as a result of the initial accommodation request.

Collaboration: Typically, PAIR, PAIMI and PADD work together to help Alaskans with disabilities secure housing or prevent the loss of housing.

Number of Cases: The Alaska P&A had 1 housing case for a PAIR-eligible individual in FY12, which was one less than anticipated.

Case Summary: In the only case presented to the Alaska P&A under this issue area, which we did open for assessment, the legal concern ended up not being related to the individual’s disability. The P&A offered some general guidance on self-advocacy to the individual and a referral to a more appropriate agency to handle their complaint.

PRIORITY: COMMUNITY INTEGRATION GOAL D: To facilitate the community integration of individuals with disabilities by protecting their rights to receive appropriate supports and services in the most integrated setting. ISSUE: Under state and federal laws people with disabilities have the right to live in integrated settings in their local communities with the appropriate supports and services. However, many individuals with disabilities who are in both large and small facilities encounter barriers which make it difficult or prevent them from living in an integrated setting. Examples of such barriers include rules and policies that have a disparate impact on individuals with disabilities, the absence of community-based services, and the diversion of scarce resources away from community-based services.

Outcome Indicators: D.1. Advocate for the development and implementation of a comprehensive, effectively working plan for ensuring community-based services for individuals with disabilities in compliance with the Americans with Disabilities Act and the U.S. Supreme Court’s decision in Olmstead (2 year priority); D.2. To advocate on behalf of 3 individuals with disabilities who are being denied appropriate community-living and assisted-living options, including elders in need of dementia care; D.3. To monitor at least 1 application for Certificates of Need regarding the construction of new facilities and increasing bed capacity to prevent the diversion of scarce resources from community-based programs and services; D.4. To assist 2 individuals with disabilities who have been denied access to programs or services because they have a disability; D.5. Advocate for systemic reform of the mental health care system within the Department of Corrections to reduce the rate of recidivism of offenders who are also Alaska Mental Health Trust beneficiaries (2 year priority).

Strategic/Resource Guidance: Examples of ADA and §504 cases include failure to provide reasonable accommodations to programs and services. Advocacy in Objective D.3 may also include efforts to challenge any changes to the Certificate of Need statutes that would eliminate public comment on proposals to build facilities for people with disabilities.

Collaboration: PAIR, PAIMI and PADD work together to assist individuals with disabilities receive services in the most integrated setting. P&A staff also collaborates with local independent living centers to help achieve this goal for our clients.

Number of Cases: Under the heading of Community Integration the P&A worked on 6 cases of individual advocacy in FY12.

Case Summary: D.1. The Alaska P&A continues to push for a comprehensive, effectively working Olmstead plan from our State. At the outset of the Olmstead decision, the P&A’s preference was to meet with the Commissioner for the Department of Health and Social Services to begin discussions in earnest on developing a plan for Alaska. When those meetings didn’t happen, and the P&A became aware of a woman in need of protection under Olmstead, we moved to sue the state. This effectively cut off any informal discussion with the Commissioner, but was in the best interest of our client and we believe this (and other necessary litigation) will ultimately move the State toward prioritizing a plan.

In Lampman v. Alaska Department of Health and Social Services et al., a woman with dementia had been in placed inappropriately in the state psychiatric hospital. Her discharge plan required her to have 1:1 staffing in order to return to an assisted living home. She applied for the Older Alaskans Medicaid Waiver, but was denied as not having physical limitations that warrant nursing facility level of care. The P&A filed to challenge the State’s failure to grant her a waiver alleging the waiver assessment tool unfairly denies individuals with solely cognitive disabilities, like dementia, equal access to the Older Alaskans Medicaid Waiver program. The case was settled in her favor and she is now residing in a nursing home after being found eligible for the Older Alaskans waiver. The State admitted, in court papers related to this case, to not having an Olmstead plan.

Olmstead litigation continues in the form of a case on ex parte holds. (Part IV. Systemic Activities and Litigation, section B. Litigation/Class Actions)

D.2 The Alaska P&A assisted just 1PAIR-eligible individual this year under this objective and that case is ongoing. The Olmstead work described above however should have a positive impact on a broad number people seeking appropriate community-living options.

D.3. No Certificates of Need came up for review in this fiscal year.

D.4. In FY12 the Alaska P&A assisted 5PAIR-elible individuals who had been denied access to programs or services. In most, the cases are ongoing so we don’t yet have outcomes to report. In the one case that did conclude in FY12, an individual with Amyotrophic Lateral Sclerosis (ALS) contacted us after the local shared-riding service for individuals with disabilities told him that they could not pick him up due to the remote location of his house. This was despite the fact he was within the approved area of pickup locations for the rideshare service. The Alaska P&A provided assistance and advice to the individual while he communicated with the rideshare service and negotiated a solution. Unfortunately, during this process, the individual lost contact with the Alaska P&A so we don’t know if the issue was resolved in his favor. We hope though, that no news is good news.

D.5. Although another grant is the primary source of funding for activity associated with this objective, it is notable here because the P&A does serve individuals who commonly have several kinds of disabilities, some of which would make them PAIR eligible.

In FY12, the first year of this 2-year objective, the Alaska P&A explored a partnership with Alaska office of the American Civil Liberties Union (AK ACLU) and launched research into the issues surrounding appropriate mental health care to prisoners. We also looked at recidivism rates in relation to the availability of mental health care to inmates and previous Alaska efforts at prison reform. The Alaska P&A and the AK ACLU plan to file an enforcement action in FY13 to ensure that prisoners have access to sufficient mental health care in accordance with state and federal law.

PRIORITY: EMPLOYMENT GOAL E: To advocate on behalf of individuals with disabilities who face discrimination in employment. ISSUE: More than 20 years after the passage of the Americans with Disabilities Act, many employers have discriminatory practices that adversely affect people with disabilities in hiring, retention, promotion and termination of employment.

Outcome Indicators: E.1. To advocate on behalf of 5 individuals with disabilities threatened with an adverse employment action, such as termination, or denied a reasonable accommodation related to their disabilities; E.2. To assist individuals with disabilities learn more about their rights by publishing and distributing 1,000 employee rights handbook.

Strategic/Resource Guidance: Assisting individuals with employment related matters may not, in all instances, include court or administrative representation (unless individuals qualifies for assistance under PABSS), but may involve the provision of self-advocacy assistance and training. If a complaint of employment discrimination is being, or should be, investigated by another agency, such as the Anchorage Equal Rights Commission, the Alaska State Commission on Human Rights, or the Equal Employment Opportunity Commission, DLC may delay its own assessment and/or make a referral to the appropriate agency. Where self-advocacy assistance is provided, staff will initiate post-assistance contact to assess the value of the self-advocacy assistance provided.

Collaboration: PAIR, PAIMI and PADD work together to assist individuals with disabilities obtain and/or maintain employment. In many cases the P&A works in collaboration with the Equal Employment Opportunity Commission and the Alaska Human Rights Commission.

Number of Cases: The P&A received 9 requests for assistance with employment issues in FY12 and was able to assist with some aspect of all 9 cases.

Case Summary: E.1. In one case, the Alaska P&A was contacted by a 65 year old woman with a visual impairment who was requesting legal representation in a discrimination suit against her former employer. When we first met her, she had already been awarded back-pay for wrongful termination from her teaching position, but the employer was contesting the outcome of that case. The P&A represented her to maintain both the award and the finding of discrimination. The termination happened when the employer learned that she was using a service animal at work and also that she was making large-print copies of materials for use in the classroom. We were very happy to assist in this clear case of discrimination—a case that reminded us how important legal advocacy remains in protecting the civil rights of people with disabilities—and the client prevailed, receiving finally $40,000 as a settlement. Although her preference would have been to keep her job in the first place, she was very happy with the outcome of her case.

In another instance, a 40-year-old woman with Multiple Sclerosis (MS) came to the Alaska P&A, again with an already favorable finding against her prior employer. She was a highly educated woman who had been working for a major hospital in their medical lab. As her MS progressed, it became necessary for her to sit during the day. A stool would have been a reasonable accommodation. The employer denied her. Then, after a medical leave she came back to work using a wheelchair, at which point she was fired. The employer tried to maintain that standing was an essential function of the job. Of course it was not and by the time we met her, the Anchorage Equal Rights Commission had already determined her former employer discriminated against her based on her disability. She asked the P&A for help in the conciliation process.

The Alaska P&A put in an entry of appearance and negotiated at length with the client’s former employer to secure the client an adequate settlement. The P&A also secured tax advice from a tax expert to further assist the client with monetary aspects of her settlement.

When our client was fired she lost her medical insurance and could not afford to extend her benefits through COBRA (the Consolidated Omnibus Budget Reconciliation Act of 1985 under which health insurance can continue when an employee leaves their job.) Her medical bills alone created a mountain of debt. Because she had been in a high-paying field though, the client was finally able to secure a substantial settlement--$200,000--which left her able to pay off debts attributed to her wrongful termination. The settlement agreement also ordered that her former employer receive training related to employing individuals with disabilities in the so that the client’s experience would never be repeated. The client is now able to focus on her well being and future medical care.

E.2. With direct-service priorities taking priority, this goal was not met.

PRIORITY: GOVERNMENT BENEFITS GOAL F: To advocate on behalf of individuals with disabilities who seek access to government benefits. ISSUE: Access to basic individual and community supports through government assistance programs is necessary for people with disabilities before they can consider independent living, continued education and employment. These supports include Social Security programs, Alaska Public Assistance, in-home support services, individualized support from state government and private providers, Medicaid, Medicare, and managed care among others.

Outcome Indicators: F.1. To assist 30 individuals with disabilities to obtain and/or maintain SSI/SSDI and related benefits, such as Adult Public Assistance; F.2. To represent 2 individuals with disabilities to obtain or retain services under Medicaid, Medicaid Waivers, Medicaid’s EPSDT program, or obtain or retain related services such as PCA services; F.3. To advocate on behalf of 20 individuals to ensure that representative payees in charge of Social Security and other public monies for these individuals uses them in accordance with their obligations under state and federal law and that Social Security properly oversees representative payees and investigates allegations of misuse of funds (2 year priority).

Strategic/Resource Guidance: Assisting individuals with disabilities obtain social security benefits; does not include the initial application process. Assisting individuals with disabilities maintain social security benefits; does not include the provision of direct legal assistance for continuing disability reviews. Assisting individuals with disabilities maintain social security benefits does not include the provision of direct legal assistance for overpayment issues unless the individual demonstrates significant cognitive impairments or qualifies for services under the PABSS grant.

Collaboration: PAIR, PAIMI and PADD work together in assisting clients to acquire benefits and in-home support services Staff also collaborates with other local agencies in outreach efforts to the homeless to secure for them the benefits to which they are entitled.

Number of Cases: In FY12 the Alaska P&A assisted 61 PAIR eligible individuals with Government Benefits issues.

Case Summary: F.1. & F.2.In FY12, as in past years, this priority is a busy one for the Alaska P&A. We had many more requests for service in this area than are apparent by looking at the Individuals Served section of this report. For instance, under Section D. Reasons for Closing Individual Case Files, the numbers show that 4 were closed due to lack of resources. Realistically though that number is much higher.

Part way through the year, when it became apparent that we would run out of PAIR funds for this priority if we took on any more cases, we effectively closed for new PAIR government benefits cases. Meaning, after determining PAIR eligibility in this issue area, we would turn potential clients away at the intake stage. This was the most prudent course of action as to not spend time further assessing cases for people the P&A knew it did not have the resources to fully represent. This also saved time for the person in need of assistance. We sent each of these individuals a list of every possible alternate representative known to us in Alaska, along with contact information for each; so that the client could quickly move on to find available representation.

That said, some examples that exemplify the importance of this priority include:

A 31-year-old woman with fibromyalgia, chronic pain, and anorexia nervosa who met one of our Legal Rights Advocates while he was on the island of Kodiak to do some training and outreach. She had just been denied her Social Security benefits, but it was immediately apparent that she was too frail to work. Meeting her was a good example of why it’s so important to get out into the more remote communities where we can assist people face to face. Sometimes just seeing the medical records doesn’t give you the full picture of how urgently benefits may be needed.

The client was able to fly to Anchorage to be present at her hearing in front of an Administrative Law Judge (ALJ). The P&A had presented well-organized and adequate medical documentation which already may have convinced the judge to award benefits, but the final decision was made quickly when he saw her condition. The client received on a fully favorable decision on the record, which allowed her to obtain proper medical treatment and other medical support right away.

In another case, the Alaska P&A was contacted by a 56-year-old woman from Kenai (a small town on the road system, but with only about 8000 residents) for help obtaining her Social Security benefits. Looking at her medical records, one should be shocked that her initial claim was denied, but in the experience of the P&A this story is all too common. Her list of Diagnoses included organic heart failure, Hepatitis C, cirrhosis of the liver, Splenomegaly (an enlargement of the spleen, which in her case was painful), degenerative disc disease, GERD (Gastro-Esophageal Reflux Disease), Osteopenia (low bone mineral density, considered by some doctors to be a precursor to osteoporosis), and Restless Leg Syndrome. The symptoms of her diagnoses contributed to constant fatigue, memory and concentration difficulties, shortness of breath, pain and stomach issues. Not surprisingly, she had also been diagnosed with anxiety and depression.

She had not worked since 2003, and prior to that time her employment consisted of a number of unskilled jobs such as a fast food worker, a housecleaner, and home health aide. None of her job skills were transferrable to alternate work that she could do with her many medical issues.

The P&A worked with the client and with her treating doctors and to prepare documents that strongly supported her inability to work. Considering her age, education, and work experience, the judge awarded her full benefits.

Under objective F.3., the Alaska P&A is representing 2 named plaintiffs in a class action regarding a past representative payee. This specific objective set a target of assisting 20 individuals. In addition to the 2 named plaintiffs, we estimate the class action will serve up to 300 people. (See details under the Part IV. Systemic Activities and Litigation section of this report.)

PRIORITY: EDUCATION GOAL G: Advocate on behalf of all children with disabilities to ensure that they have access to a free appropriate public education and are not subject to discrimination for reasons related to their disabilities. ISSUE: Under state and federal law, students with disabilities have the right to be educated in integrated settings and to participate meaningfully in academic and non-academic activities with non-disabled children. Lack of information about special education laws is just one of many barriers preventing Alaskans with disabilities from benefiting from their special education programs.

Outcome Indicators: G.1. Advocate on behalf of 2 children with disabilities whose education plans are either wholly or substantially inadequate and/or inappropriate; G.2. Advocate on behalf of 1 child with disabilities whose school district has failed to comply with procedural protections, including child find, to which children and their parents are entitled.

Strategic/Resource Guidance: Under Objective G.1., children with disabilities without any education plan will be prioritized over children receiving inadequate services. Otherwise, prospective cases will be prioritized in the following order of importance: inappropriate placement decisions; the lack of required related services; the lack of appropriate transition services; the lack of needed supplementary aids and services; and inadequate 504 plans. Under Objective G.2., prospective cases primarily involving procedural violations will be prioritized in the following order of importance: Child Find; Evaluations; IEP Development & Parental Participation; Independent Educational Evaluations; Manifestation Determinations & Disciplinary Procedures; and Access to Records. Special attention will also be paid to whether or not the school district provided the parents with proper notice, including Prior Written Notice, Notice of Procedural Safeguards, Notice of IEP Team Meeting, and Notice of Disciplinary Action. Promoting self-advocacy will be an essential factor in all case assessments, which assessment will occur prior to the execution of an advocacy or representation agreement.

Collaboration: n/a Number of Cases: n/a

Case Summary: While the Alaska P&A did advocacy work on behalf of many children and young adults with disabilities during FY12, none of them would be appropriately reported under PAIR.

When we set our priorities and objectives each year, the P&A does so ‘on the whole’ without initially separating each by grant area. Education has always been one of our agency’s priority areas (and will continue to be) and in years past we have noted that in our PAIR report. As we try to hone the quality of our reporting however, it has become apparent that the education goals are rarely appropriate to this grant. For that reason, you won’t see Education noted in our FY13 priorities, nor do we have a further update for PAIR in this area for FY12.

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.

DISABILITY LAW CENTER OF ALASKA FY2013 PAIR PRIORITIES, GOALS, OUTCOME INDICATORS

PRIORITY: ABUSE AND NEGLECT

GOAL A: To investigate allegations of abuse (including the use of seclusion and restraint) neglect, and exploitation of individuals with disabilities.

ISSUE: Individuals with disabilities have a right to be free from abuse and neglect.

Outcome Indicators: A.1. Investigate 3 reports of abuse and neglect of individuals with disabilities; A.2. Assess whether, in at least 3 investigations, all federal, state, and local agencies charged with the responsibility of investigating complaints of abuse and neglect of individuals with disabilities conduct their investigations in a timely, thorough and objective manner; A.3. Establish and maintain contact with residents of assisted living homes, nursing facilities, psychiatric facilities (adult and child), prisons, jails, and in Division of Juvenile Justice facilities, through at least 5 facility visits;

Strategic/Resource Guidance: Complaints alleging the following abuse will be prioritized: suspicious death, seclusion & restraint, eminent threat of harm, sexual misconduct; Complaints originating in facilities with repeated complaints of abuse and neglect will be prioritized; If a complaint of abuse or neglect is being investigated by the police, DLC may delay its own investigation pending the outcome of that investigation; DLC will prioritize monitoring facilities in rural hub communities and those facilities where residents have restricted access to communicating with DLC and other advocacy organizations.

PRIORITY: OUTREACH

GOAL B: To provide outreach to unserved/underserved individuals with disabilities in Alaska.

ISSUE: Individuals with disabilities who are unaware of their rights can neither exercise those rights, nor protect themselves from rights abuses.

Outcome Indicators: B.1. To conduct 10 outreach, intake, and/or, training events statewide for the purpose of informing people with disabilities of the services available to them through the P&A; B.2. To conduct 4 training events statewide for the purpose of informing people with disabilities of their legal rights and self-advocacy strategies, including information on housing rights & employment rights; B.4. To disseminate to 100 rural clinics information on education rights and appropriate educational programming for students with traumatic brain injury. Strategic/Resource Guidance: Outreach activities may be suspended when caseloads involving direct legal advocacy exceed manageable resource levels. *B1. outreach, intake and/or training events will include: Information on services available through DLC to clients or potential clients of the Division of Vocational Rehabilitation, Tribal Vocational Rehabilitation and/or Independent Living Centers;

PRIORITY: HOUSING

GOAL C: To advocate on behalf of individuals with disabilities for housing and to prevent homelessness.

ISSUE: Being part of the community and living as independently as possible are among the most important values and goals shared by people with disabilities, their families, friends, and advocates. A home of one’s own — either rented or owned -- is the cornerstone of independence for people with disabilities. However, across the nation, individuals with disabilities face a crisis in the availability of decent, safe, affordable, and accessible housing.

Outcome Indicators: C.1. To advocate on behalf of 2 individuals with disabilities who have complaints of Fair Housing Act and other housing rights violations related to the disability, or require assistance in requesting a reasonable accommodation.

Strategic/Resource Guidance: DLC will prioritize assisting individuals in institutions at risk of losing their community-based housing as a result of institutionalization, but not incarceration.

PRIORITY: COMMUNITY INTEGRATION

GOAL D: To facilitate the community integration of individuals with disabilities by protecting their rights to receive appropriate supports and services in the most integrated setting.

ISSUE: Under state and federal laws people with disabilities have the right to live in integrated settings in their local communities with the appropriate supports and services. However, many individuals with disabilities who are in both large and small facilities encounter barriers which make it difficult or prevent them from living in an integrated setting. Examples of such barriers include rules and policies that have a disparate impact on individuals with disabilities, the absence of community-based services, and the diversion of scarce resources away from community-based services.

Outcome Indicators: D.1. Advocate for the development and implementation of a comprehensive, effectively working plan for ensuring community-based services for individuals with disabilities in compliance with the Americans with Disabilities Act and the U.S. Supreme Court’s decision in Olmstead; — 2nd year of 2 year priority D.2. To advocate on behalf of 3 individuals with disabilities who are being denied appropriate community-living and assisted-living options, including elders in need of dementia care; D.3 To assist 2 individuals with disabilities who have been denied access to programs or services, or who have had their rights infringed upon based on disability; D.4. Advocate for systemic reform of the mental health care system within the Department of Corrections to reduce the rate of recidivism of offenders who are also Alaska Mental Health Trust beneficiaries — 2nd year of 2 year priority; D.5. Advocate for mental health evaluations under the civil commitment system to be done as close to the respondents home as possible — 1st year of 2 year priority;

Strategic/Resource Guidance: n/a

PRIORITY: EMPLOYMENT

GOAL E: To advocate on behalf of individuals with disabilities who face discrimination in employment.

ISSUE: More than 20 years after the passage of the Americans with Disabilities Act, many employers have discriminatory practices that adversely affect people with disabilities in hiring, retention, promotion and termination of employment.

Outcome Indicators: E.1. To advocate on behalf of 5 individuals with disabilities threatened with an adverse employment action, such as termination, or denied a reasonable accommodation related to their disabilities;

Strategic/Resource Guidance: Assisting individuals with employment related matters may not, in all instances, include court or administrative representation, but may involve the provision of self-advocacy assistance; If a complaint of employment discrimination is being, or should be, investigated by another agency, such as the Anchorage Equal Rights Commission, the Alaska State Commission on Human Rights, or the Equal Employment Opportunity Commission, DLC may delay its own assessment and/or make a referral to the appropriate agency.

PRIORITY: GOVERNMENT BENEFITS

GOAL F: To advocate on behalf of individuals with disabilities who seek access to government benefits.

ISSUE: Access to basic individual and community supports through government assistance programs is necessary for people with disabilities before they can consider independent living, continued education and employment. These supports include Social Security programs, Alaska Public Assistance, in-home support services, individualized support from state government and private providers, Medicaid, Medicare, and managed care among others.

Outcome Indicators: F.1. To assist 40 individuals with disabilities to obtain and/or maintain SSI/SSDI and related benefits, such as Adult Public Assistance; F.2. To represent 2 individuals with disabilities to obtain or retain services under Medicaid, Medicaid Waivers, Medicaid’s EPSDT program, or obtain or retain related services such as PCA services; F.3 To advocate on behalf of 20 individuals to ensure that representative payees in charge of Social Security and other public monies for these individuals uses them in accordance with their obligations under state and federal law and that Social Security properly oversees representative payees and investigates allegations of misuse of funds — 2nd year of 2 year priority.

Strategic/Resource Guidance: Assisting individuals with disabilities obtain social security benefits does not include the initial application process; Assisting individuals with disabilities maintain social security benefits does not include the provision of direct legal assistance for Continuing Disability Reviews; Assisting individuals with disabilities maintain social security benefits does not include the provision of direct legal assistance for overpayment issues unless the individual demonstrates significant cognitive impairments.

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

PART VI. NARRATIVE: A. Sources of funds received and expended: Provide the amount of funds the PAIR program received from each of the sources indicated during the fiscal year covered by this report. In addition, specify the total amount expended, from each of the sources of funds, in providing services to PAIR-eligible individuals. Provide this information even if the PAIR’s only source of funding is the Federal formula grant under section 509 of the Act. The following chart is recommended when providing this information:

Source of Funding Amount Received Amount Spent Federal (section 509) 175,300 166,926 State 0 0 Program income 8,766 8,766 Private 0 0 All other funds 21,092 21,092 Total (from all sources) 205,158 196,784

B. Budget for the fiscal year covered by the report:

Category Prior Fiscal Year Report Fiscal Year Wages/salaries 96,293 83,936 Fringe benefits 39,737 39,829 Materials/supplies 4,087 2,843 Postage 623 492 Telephone 2,493 2,359 Rent 14,371 15,756 Travel 5,818 3,084 Copying 3,117 2,427 Bonding/insurance 831 1,081 Equipment 0 0 Legal services 1,000 1,000 Indirect costs 49,639 40,339 Miscellaneous 8,282 6,481 Total Budget 226,291 199,627

C. Description of PAIR staff: Provide a description of the PAIR staff in terms of "person-years" and duties. "Person-years" refer to the actual time that positions (both professional and clerical) were filled during the period covered by this annual report. If a position was filled throughout the year, it counts as one person-year. For those positions that were filled for only a fraction of the year, you will have to calculate the "person-year" for that position by first calculating the "full-time equivalents (FTEs)" for that position. Person-years should be reported for all PAIR personnel whose salaries are paid fully or partially by section 509 funds. Be sure to include an explanation of the number of full-time part-time, and vacant positions.

Executive Director - .02 FTE from this grant. This Anchorage-based position provides overall direction for the PAIR project. The Executive Director is also responsible for the administration of the organization and reports to the Board of Directors.

Legal Director - .20 FTE from this grant. This Anchorage-based position provides day-to-day supervision of Protection and Advocacy services, including both legal and non-legal advocacy. This position reports to the Executive Director.

Staff Attorneys — 0.72 FTE from this grant. These four positions are supervised by the Supervising Attorneys. The Staff Attorneys provide support to the program’s Legal Advocates, as well as providing training and legal assistance to clients.

Legal Advocates — .45 FTE from this grant. These positions provide general agency intake and advocacy services, and are responsible for conducting training and outreach activities. One position (.10) was vacant throughout the year.

Paralegal - .16 FTE from this grant. This Anchorage-based position provides legal and clerical support to the staff attorneys and advocates, primarily with conducting legal research, case file organization and maintenance, and the copying and organization of training materials for education and outreach activities.

Development Coordinator — 0.15 FTE from this grant. This Anchorage-based position has responsibility for the coordination, quality and supervision of outreach services including presentations, training, community awareness education and street outreach. This position reports to the Executive Director.

Type of Position FTE % of year filled Person-years Professional Full-time .79 100% .79 Full-time .13 33% .04 Part-time 0 0 0 Vacant .25 0% .0 Clerical Full-time 0 0% 0 Part-time 0 0 0 Vacant 0 0 0

D. Involvement of Advisory Boards

The Alaska P&A does not have an advisory board for the PAIR program.

E. Grievance Filed Under the Grievance Procedure

There were no grievances filed under the PAIR program during the relevant reporting period.

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

Beginning in FY12 the CAP is operated by the P&A in Alaska. The P&A works closely with the Long Term Care Ombudsman on issues related to nursing homes and senior citizens.

Certification

Signed?Yes
Signed ByKaren Tessandore
TitleDevelopment Coordinator
Signed Date12/20/2012