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


General Information

Designated Agency Identification

NameMaryland Disability Law Center (MDLC)
Address1500 Union Avenue
Address Line 2Suite 2000
Zip Code21211
Website Address
TTY 410-727-6387
Toll-free Phone800-233-7201
Toll-free TTY800-233-7201
Name of P&A Executive DirectorVirginia Knowlton
Name of PAIR Director/CoordinatorLauren Young
Person to contact regarding reportLauren Young
Contact Person phone410-727-6352

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 areas262
2. Individuals receiving I&R outside PAIR priority areas68
3. Total individuals receiving I&R (lines A1 + A2)330

B. Training Activities

1. Number of trainings presented by PAIR staff25
2. Number of individuals who attended training (approximate)637

PAIR staff was asked to participate in Baltimore City’s “Homeless Connect Day” held at the City’s professional football stadium. The purpose of the day was to for community agencies to provide information about their services directly to homeless individuals. PAIR staff provided general information, distributed written material and provided one to one counseling on several matters raised by homeless individuals with disabilities.

PAIR staff was asked to meet with the Chief of Staff for a member of the Congressional budget “super committee” to discuss the impact of housing cuts. Staff focused on the need for affordable housing as an alternative to institutional and nursing facility placement and discussed how such housing can save health care costs. Staff was asked to provide follow up information on the research studies described in the presentation, which was subsequently provided.

PAIR staff was asked to conduct two workshops at the National Disability Rights Network (NDRN) Conference. The first workshop was an introduction to fair housing and rights of persons with disabilities. The second workshop focused on the use of available strategic advocacy tools to increase access and housing resources for persons with disabilities. PAIR staff distributed materials and used a power point presentation during the training. The oral presentation was followed by a question and answer session. Hypothetical cases were discussed to highlight application of the training to case services.

PAIR staff made a presentation to Department of Disabilities Advisory Commission on housing priorities for persons with disabilities, for purposes of establishing priorities in the Department’s State Plan. Staff presented orally and provided written material advocating potential actions for the State to adopt.

PAIR staff provided a housing training to individuals and a self-advocacy group at Health Care for the Homeless. The purpose of the training was to familiarize participants with fair housing issues and various subsidy programs for which they might be eligible. Staff provided an oral presentation, distributed handouts, and held a question and answer session following the oral presentation. After the general session, PAIR staff was available to discuss individual circumstances for persons wanting confidential time with an attorney on a housing matter.

PAIR staff provided outreach and training to staff and consumers of a day shelter program. The purpose of the training was to inform low-income individuals with disabilities about subsidized housing, how to navigate waiting lists and applications, how to request reasonable accommodations, and dealing with potential credit or screening issues. Methods of training included oral presentation, powerpoint slides, distribution of written material, question and answer session, and one-on-one individual counseling following the group presentation.

PAIR staff provided a presentation to a group of individuals with disabilities who received vouchers from the Baltimore City Housing Authority but had not yet leased a housing unit. The presentation focused on the use of reasonable accommodations and modification funds that are available to assist in making a potential apartment unit more accessible. Brochures were developed and distributed.

PAIR staff hosted a two-hour meeting for users of paratransit services at the League for People with Disabilities. Riders had the opportunity to discuss issues of concern and to learn about changes in services and their rights. A survey was provided to the audience to rank their most significant issues and ensure that PAIR staff addressed those issues. Information was presented orally and through question and answer time.

PAIR staff participated with clients in two forums to educate the public and legislators about existing limitations in using housing choice vouchers due to landlords refusing to participate in the housing choice voucher program. PAIR staff and clients spoke informally with people at each forum to explain how newer housing is often not available to people who use vouchers, yet older housing is generally not accessible and is not required to be accessible. PAIR staff also assisted a client who attended a forum and was asked meet with two legislators to discuss this issue in detail.

PAIR staff was asked to provide a presentation on permanent supportive housing for the National Housing Law Project’s Housing Justice Network Conference. PAIR staff made an oral presentation and distributed written materials. A discussion session was included in the training that focused on integrated housing, rights of tenancy, and the need for voluntary support services for persons with disabilities.

PAIR staff was asked to coordinate a presentation to the Critical Barriers Committee of the Access to Justice Committee of the Maryland Court of Appeals. PAIR staff identified six individuals with disabilities to provide a presentation to the Committee. The individuals provided oral presentations on barriers to the court system and included a person who has a mental health diagnosis and works with consumers with mental health disabilities; a person who is deaf and represents other individuals who are deaf or hard of hearing; two persons who are blind and work with individuals with various disabilities and the National Federation of the Blind; and individuals who use a wheelchair and advocate for persons with disabilities. The presentations were followed by questions from Committee members and discussions related to removing barriers identified by various individuals.

PAIR staff was asked to participate in a career panel for the Student Health Law Organization at the University of Maryland School of Law. The focus of the presentation by PAIR staff was to provide information about health care issues of priority to persons with disabilities, the significance of long term care reform, and potential employment opportunities for persons interested in such work. An oral presentation was followed by discussion.

PAIR staff was asked to provide a presentation on disability rights for the annual conference of the Maryland Association of the Deaf. The focus of the training was effective communications for persons who are deaf or hard of hearing. Staff made an oral and power point presentation and engaged in a question and answer session as part of the training provided.

PAIR staff was asked to present to legal directors about training lawyers to focus on systemic advocacy on behalf of persons with disabilities. The presentation was oral and included discussion during a day of training hosted by the National Disability Rights Network. PAIR staff was asked by the Epilepsy Foundation to present a webinar to the Lennox-Gastaux Society. The presentation included an oral presentation and use of slides. The presentation focused on transition services for students with disabilities.

PAIR staff provided ten trainings to volunteer "Sunshine Folk" peer advocates who provide information about options for services to nursing facility residents. Trainings included role-playing activities to practice the new skills learned, oral presentations, and a question and answer session. Most of the trainings also included power point presentations. Training topics included: voting rights of nursing facility residents and residents with guardians; fair housing rights of persons with disabilities; resident access to family, friends, ombudsmen, and protection and advocacy staff; service options under Medicaid waivers; communication skills; people first language and modeling respectful work; access to nursing facilities and residents; empowering residents to protect themselves from abuse and neglect; and paratransit service options and application processes.

C. Information Disseminated to the Public

1. Radio and TV appearances by PAIR staff2
2. Newspaper/magazine/journal articles3
3. PSAs/videos aired1
4. Hits on the PAIR/P&A website22,435
5. Publications/booklets/brochures disseminated1,827
6. Other (specify separately)0


The total number of MDLC website pages viewed is 76,165 this past program year. Data analysis demonstrates that the most popular page is the "publications" page where visitors to the website can read and print copies of various handbooks and brochures or fact sheets provided by MDLC. Access to publications is not counted in the data cited in C.5.above.

At the close of the fiscal year, MDLC’s Facebook page has 787 followers and in September 2012, we received 10,889 post views.

MDLC’s electronic distribution list has slightly over 400 contact names. MDLC uses the list about 10 times per year to share information about our successful cases and to spread other news of interest to the disability community in Maryland.

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)52
2. Additional individuals served during the year52
3. Total individuals served (lines A1 + A2)104
4. Individuals w. more than 1 case opened/closed during the FY. (Do not add this number to total on line A3 above.)3

B. Individuals served as of September 30

Carryover to next FY may not exceed total on line II. A.3 above 39

C. Problem Areas/Complaints of Individuals Served

1. Architectural accessibility1
2. Employment0
3. Program access0
4. Housing82
5. Government benefits/services0
6. Transportation4
7. Education12
8. Assistive technology0
9. Voting0
10. Health care7
11. Insurance0
12. Non-government services0
13. Privacy rights0
14. Access to records0
15. Abuse0
16. Neglect0
17. Other0

D. Reasons for Closing Individual Case Files

1. Issues resolved partially or completely in individual favor52
2. Other representation found4
3. Individual withdrew complaint0
4. Appeals unsuccessful1
5. PAIR Services not needed due to individual's death, relocation etc.1
6. PAIR withdrew from case0
7. PAIR unable to take case because of lack of resources0
8. Individual case lacks legal merit4
9. Other3

Please explain

In the 3 cases closed as "other" PAIR staff provided technical assistance to clients so they could advocate for themselves. Clients are informed that they may call back if the situation does not resolve. However, if we did not get a return call from the client, we did not mark the case as "resolved in client’s favor."

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 assistance34
3. Investigation/monitoring4
4. Negotiation26
5. Mediation/alternative dispute resolution0
6. Administrative hearings1
7. Litigation (including class actions)1
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 - 41
2. 5 - 2218
3. 23 - 5962
4. 60 - 6411
5. 65 and over12

B. Gender of Individuals Served

Multiple responses not permitted.

1. Females55
2. Males49

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. Asian1
4. Black or African American68
5. Native Hawaiian or Other Pacific Islander1
6. White31
7. Two or more races0
8. Race/ethnicity unknown0

D. Living Arrangements of Individuals Served

Multiple responses not permitted.

1. Independent47
2. Parental or other family home33
3. Community residential home2
4. Foster care1
5. Nursing home2
6. Public institutional living arrangement0
7. Private institutional living arrangement4
8. Jail/prison/detention center3
9. Homeless12
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 impairment4
2. Deaf/hard of hearing4
3. Deaf-blind0
4. Orthopedic impairment29
5. Mental illness0
6. Substance abuse0
7. Mental retardation0
8. Learning disability3
9. Neurological impairment14
10. Respiratory impairment4
11. Heart/other circulatory impairment3
12. Muscular/skeletal impairment17
13. Speech impairment1
15. Traumatic brain injury0
16. Other disability22

Part IV. Systemic Activities and Litigation

A. Systemic Activities

1. Number of policies/practices changed as a result of non-litigation systemic activities21

2. Number of individuals potentially impacted by policy changes22,000

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

The following describe PAIR systemic activities to ensure access for persons with disabilities to: 1) affordable and accessible housing, 2) reliable public transportation services, and 3) community based health care services for persons residing or at risk of placement in nursing facilities.1. Activities to Ensure Access for People with Disabilities to Affordable and Accessible Housing:

A former legal services attorney contacted PAIR staff to express concerns about the admission and screening practices of a housing provider that offers housing to persons with disabilities. PAIR staff investigated the concerns and arranged a meeting with the housing provider. During the meeting, PAIR staff explained concerns and was convinced the provider that their application and screening practices were discriminatory. The application, for example, asked whether the individual applicant had a psychiatric diagnosis, whether the individual had ever been referred to a mental health counselor, whether the applicant was on medications, and for other confidential health information. The application also failed to notify the applicant that they could request an informal review of a denial of their application for housing. Further, the application asked about prior criminal history without regard to the seriousness of the alleged offense, whether the individual was convicted of any crime, and without providing for mitigating circumstances. Finally, the provider did not offer the requisite notice and due process rights for tenants upon termination of tenancy. PAIR staff reviewed the policies of the provider and suggested changes. The provider, which has capacity for approximately 200 individuals, made significant changes to their application, screening, eligibility and termination processes as a result of MDLC’s advocacy. An example of how this change helps applicants with disabilities includes that an individual with a history of psychiatric disabilities was forced to disclose private health information which interfered with his privacy rights and his fair housing rights. Another example of how these policies impact persons with disabilities is that a young adult who uses a wheelchair was improperly terminated from housing leaving him homeless because he was not provided proper appeal procedures by the provider. As a result of meetings with PAIR staff, the provider deleted questions about an applicant’s health status, provided written notice that persons can request reasonable accommodations, provided notice that mitigating circumstances will be considered prior to denying applicants based on alleged criminal background information (except as restricted by federal law) and set forth timelines for informal grievance processes and appeals. The provider also changed its practices so that supportive services are voluntary and not a requirement for tenancy.

PAIR staff represented a person with physical disabilities who uses a wheelchair and who was living in transitional housing. The client had come to the top of the waiting list for a privately owned, subsidized housing program but the client’s application for tenancy was denied. The denial letter was confusing, did not list the reasons why the client was denied and implied that the client could not appeal the denial unless he could prove errors on his rental application and credit report. PAIR staff assisted the client in appealing the tenancy denial and requesting reasonable accommodations based on his disability. The client was accepted as a tenant. After the client was offered only a single room occupancy unit, PAIR staff again intervened to successfully tenant’s expense. PAIR staff provided the client with legal citations and advice on how to write a demand letter to the landlord. PAIR staff offered to contact the landlord directly and to request the needed modifications if the client did not receive a positive reply. After receiving the letter with legal citations, the management company’s legal department reversed their advice and the company installed the strobe lights to work with the existing fire alarms. The client reported that tests of the system established that it worked well and that he was satisfied.

While investigating on behalf of a client who was denied eligibility for a housing voucher from the Housing Authority of Baltimore City (HABC), PAIR staff learned that individuals residing in transitional housing were not informed of their rights to reasonable accommodations. The lack of information about rights to reasonable accommodations affects tenancy rights including continued occupancy and the ability of tenants to retain eligibility for a permanent housing voucher after completion of tenancy in transitional housing. Our client was facing eviction from a transitional program due to her non-compliance with program rules. She had a defense to the program violation related to her disability. PAIR staff successfully brought this issue to the attention of HABC which agreed to change its Administrative Plan. The Administrative Plan now states that if a tenant is discharged from transitional housing, he or she may request reasonable accommodations if he or she believes such accommodations would allow him or her to successfully meet the obligations of the voucher program. This is important because it preserves individuals’ eligibility rights for public housing, project based vouchers and housing choice tenant vouchers.

PAIR staff participated in the development of a proposal that was submitted to the Department of Housing and Urban Development (HUD) from the state Department of Housing and Community Development in partnership with the Department of Health and Mental Hygiene and the Department of Disabilities. The proposal requested nearly eleven million dollars to create 100 subsidized rental units over the next five years for non-elderly persons with disabilities. PAIR staff shared knowledge gained from developing rental units pursuant to the Bailey Consent Decree and from experience working with its housing clients. Experts from the Technical Assistance Collaborative, who were experts for MDLC in the Bailey housing case, worked with the state and stakeholders to develop the proposal and also drew upon lessons from the Bailey case. The award announcement from the federal government is imminent. PAIR staff cannot yet report that persons with disabilities will be positively affected by this policy initiative, but are hopeful that the positive impact from this new state initiative will be reported upon next fiscal year. The collaboration among agencies to focus on housing needs of persons with disabilities will be beneficial to such individuals.

PAIR staff represented a woman with physical disabilities renting a unit in a senior housing development. The client requested approval of a live-in-aide who is under 55 years of age. The request was denied by the client’s condominium association. PAIR staff negotiated with the attorney for the condominium association who initially insisted that zoning restrictions for the senior housing development required age restrictions and that the client would need to obtain a waiver from the County to have a live in aide under age 55. Ultimately, PAIR staff convinced the condominium association that the provisions of the Fair Housing Act pre-empted local zoning restrictions. The attorney for the condominium association recognized the rights of persons with disabilities to reasonable accommodations. The impact for our client was that her tenancy termination notice was rescinded and her live-in aid was permitted to remain in her unit. Other residents with disabilities may also benefit from this change in policy from the condominium association.

When reviewing a client’s housing file, PAIR staff noticed a document that informed residents in project based housing units operated by the Housing Authority of Baltimore City (HABC) that the residents did not have the right to move with a tenant voucher at a later date. Such notice is in violation of the HABC Administrative Plan. PAIR staff notified the General Counsel for HABC and requested that tenants be informed that they have a right to request a tenant based voucher if they reside in a project based unit for a year and HABC is issuing vouchers. HABC agreed to change their practice and revise their documents. This is significant to persons with disabilities who are residing in project based units as the right to a tenant based voucher provides tenants with opportunities for housing choice and mobility if they desire to move after a year of residence in the project based unit. Our client was informed that she could apply for a tenant voucher and move. This policy disproportionately affects persons with disabilities as HABC has set aside a significant number of project based vouchers for persons with disabilities.

While investigating a client’s concern related to laundry equipment, PAIR staff realized that several of the amenities promised by the developer of a new tax credit development were not provided to tenants. PAIR staff complained to the property manger. PAIR staff also contacted the State Department of Housing and Community Development, the agency that awarded the tax credits based upon the developer’s proposal. The state housing office agreed to investigate our claims, which included that tenants were not provided with services from the Center for Urban Families; that the computers that were promised to be available to tenants were never provided; and that the community room was not available for tenants. The housing developer ultimately agreed to provide those amenities that were part of the developer’s tax credit proposal. PAIR clients with disabilities, who occupy a number of units designated for persons with disabilities in the development, now have access to services and promised amenities.

The December 2011 Baltimore Metropolitan Regional Analysis of Impediments (AI) identifies the lack of accessible housing as a barrier to fair housing as a result of advocacy efforts by PAIR staff and its clients. The AI’s recommendations for a Fair Housing Action Plan includes, as one of nine identified actions, the creation of more accessible and affordable housing. PAIR staff submitted written comments on the lack of affordable, accessible units in Baltimore City and Baltimore County during the development of local and regional AI reports. PAIR staff attended a public hearing on the AI where PAIR staff and clients made presentations about the need for more accessible housing. Four clients who use wheelchairs participated in this hearing.

2. Activities to Ensure that People with Disabilities Have Access to Reliable Public Transportation Services:

PAIR staff continues to meet regularly with Maryland Transit Administration (MTA) officials and a group of dedicated PAIR clients. These meetings and communications have produced great benefits for our clients and resulted in improvements in service. Examples of changes in policies or practices resulting from this collaboration include the following:

After receiving and reporting numerous complaints to MTA about problems that clients experienced in accessing the paratransit telephone system, MTA extended phone service hours until seven o’clock in the evening, providing riders with two additional hours to allow people to make trip reservations. The goal of proving the extra hours is to reduce telephone hold times and increase the availability of services. MTA also increased the number of trips that callers could schedule in one call, thus reducing customers’ need to call repeatedly to the call center to book rides.

After PAIR staff reported complaints regarding late trips and long trips, and after reviewing data showing some growth in trip length, MTA reported that it added more runs to its service to increase the number of vehicles providing service.

The Maryland Transit Administration (MTA) continues to inform PAIR staff immediately in the event of power outages or emergency changes to paratransit services. MDLC posts such alerts on its website and Facebook page. This MTA policy provides more opportunity for persons with disabilities who use paratransit services to receive essential information as quickly as possible. This policy has resulted in communications between PAIR staff and MTA during Hurricane Sandy and during power outages affecting the MTA telephone system. PAIR staff also notified MTA when MTA’s web page failed to provide a correct alternative contact number for paratransit services during power outages.

MTA officials met with PAIR staff and clients to discuss its planned change in service area. The change affected approximately 900 individuals. MTA proposed to provide affected individuals a Taxi Access program whereby they could take up to two rides a day at a subsidized rate. PAIR staff informed MTA that Taxi Access did not have sufficient accessible taxis for the offer to be meaningful to people who need accessible service. PAIR staff also informed MTA that its clients could not get accessible taxi service in Baltimore County. PAIR staff and clients met numerous times with MTA to avoid litigation over the proposed change which would have deprived persons with disabilities who use wheelchairs and cannot transfer into a sedan taxi from having an equal opportunity to use public transit. MTA agreed to undertake an analysis of riders who need accessible cabs. After such analysis, MTA agreed to provide thirteen accessible taxis (doubling the number of such vehicles). MTA also agreed to provide accessible taxi service in and to Baltimore County. MTA provided three accessible cabs for Baltimore County and provided that contracts for City taxis require that City cabs provide service to residents who live in the County. (Taxi services regulated through the Public Service Commission cannot dispatch to the County if they are licensed in the City.) The increase in availability of accessible cabs provides persons with disabilities access to same day transportation services. This service is now available to residents of Baltimore County who reside in areas served by paratransit services. In addition, the increase in vehicles will allow persons who use wheelchairs and motorized scooters much greater access to publicly subsidized transportation services. PAIR staff will continue to advocate with MTA on this issue in the next fiscal year to ensure that MTA paratransit customers are aware of the new opportunities.

PAIR staff represented individuals who were at risk of losing MTA partransit services. Some such individuals needed service to continue to get to their dialysis treatments. In one case, MTA agreed to continue providing service to a PAIR client while PAIR staff arranged for the client to be provided transportation to dialysis through Medicaid. In another case, MTA agreed the client could continue to receive the paratransit service. In this latter case, the client was living in an assisted living facility where she was able to get paratransit services three times each week (6 trips per week) for dialysis treatments. The client wished to return to her home where she was informed she was no longer eligible for paratransit service and she had no other transit options. She is a retired teacher and ineligible for Medicaid. However, the client is not able to afford the cost of taxi services for dialysis, which would cost nearly five hundred dollars per month. PAIR staff negotiated with MTA with the result that the client is able to use paratransit service from her home.

During regularly scheduled meetings between MTA officials and PAIR staff and clients, PAIR staff alerted MTA to problems with the certification and re-certification process for paratransit customers. PAIR staff sent a follow up letter to MTA documenting the problems. Complaints from clients and riders included the inability to get through on the phone system to speak with someone about scheduling their certification/re-certification process or to follow-up with paperwork, the inability to get appointments, and complaints that paperwork submitted was lost or ignored. Examples of clients affected include an individual who tried to recertify for paratransit by repeatedly sending in doctor information and trying to schedule appointments for a period extending over several months. Another client example involved problems accessing the certification office by telephone. A client reported trying to call into the certification office during regular business hours for two days. He called repeatedly during the two days but was unable to get a person to speak with him and was also unable to leave a message on the MTA phone line dedicated for certification and re-certification. At times the phone would ring but was never answered; at other times the phone would click off and the call was dropped. The problems were reported by other clients and were shared with MTA by PAIR staff. These problems impact people’s ability to access public transit services. PAIR staff also informed MTA that applicants for service were not being provided with service when their applications were not timely processed. PAIR staff wrote to MTA to request that access to certification staff be timely provided and that MTA provide written assurance that people whose applications are not processed wihtin 21 days are notified that they are eligible to use the service pending processing of their application, as required by federal law. Subsequent to these communications, MTA determined to staff the recertification phone line with live personnel and changed the phone system. MTA re-assigned staff to process certification applications, and confirmed in writing that they will inform customers in writing that if they do not receive certification notices within 21 days of MTA’s receipt of a certification/re-certification application, that the customer is presumptively eligible for service pending processing of their application. MTA also decided to provide their applications on-line.

PAIR staff and clients suggested to MTA that they have a longer eligibility or tiered recertification process for persons with demonstrated long term disabilities in lieu of requiring everyone to re-certify once a year. This is significant for our clients as the paratransit service reported receipt of approximately 1,200 applications per month, a volume that put significant stress on the system and created backlog in processing the applications. MTA agreed to a longer certification period for some customers based on the certifications of their health care providers. This change is useful for persons with disabilities who were inconvenienced by having to reapply for services and because numerous clients reported problems getting through to MTA, having paperwork lost and/or being unable to schedule appointments to recertify.

In response to complaints of PAIR staff and clients, MTA altered the computerized voice on the new automated voice recognition software program as clients found it hard to understand.

In response to complaints and detailed concerns of PAIR staff and clients, MTA initiated a new customer service training for reservation agents and shared the training protocol with PAIR staff and clients. The customer training includes that reservation agents listen to the MTA complaint line so they understand some of the frustration and concerns of riders, and also that the agents must ride on paratransit vehicles so they can better empathize with customers and know what they may experience.

PAIR staff negotiated with MTA to provide an informal hearing process for persons who are denied eligibility for paratransit services. MTA designated the Office of Administrative Hearings to handle contested cases. This offers significant protections for PAIR clients. An example of the significance of this issue is a case where PAIR staff collaborated with PADD staff in representing a gentleman who had intellectual disabilities and was denied eligibility for MTA paratransit services. At a contested hearing, the Administrative Law Judge found the client eligible for services. This experience has alerted PAIR staff to other systemic issues with the MTA eligibility process and specifically its use of a "FACTS" assessment for eligibility.

PAIR staff and clients complained that customers make complaints to MTA but do not receive a response to their filed complaints. PAIR staff provided numerous examples of such complaints so MTA could investigate their status. MTA responded by reassigning staff to ensure prompt handling of complaints. MTA also implemented a complaint tracking system to monitor the response time to complaints.

3. Activities to Ensure Access to Community Based Health Care Services for Persons Residing or at Risk of Placement In Nursing Facilities:

PAIR staff participated in a Long Term Services Supports and Reform Committee established by the Maryland General Assembly. The implementing legislation specifically named Maryland Disability Law Center as a member of this Committee. As a participant on this Committee, PAIR staff advocated for the State to act quickly to embrace opportunities under the Affordable Care Act (ACA). PAIR staff provided written recommendations to the Committee, the Deputy Secretary for Medicaid, and the Secretary of the Department of Health and Mental Hygiene (DHMH). The Committee endorsed opportunities available through the Community First Choice option and the Balancing Incentive Payment Program in the ACA, consistent with recommendations of PAIR staff. The recommendations will make community services more available to persons with disabilities and help such persons avoid institutional or facility placement.PAIR staff continued to collaborate with representatives from DHMH, the State Department on Aging, the Department of Disabilities, and a local Area Agency on Aging to develop a pilot and outcome measures for the “Options Counseling Protocol.” The purpose of the protocol is to enable consumers to obtain information about long term services and supports and provide guidance on those options for which they may be eligible. The model is currently being piloted in one county, with the expectation that each of Maryland’s ten Aging and Disability Resource Centers (ADRCs) will adopt such protocols. PAIR staff worked to strengthen the protocol, in particular the communication accommodation section. PAIR staff also successfully advocated for the protocol to use a supported decision making model rather than a substituted decision making model.PAIR staff was appointed to DHMH’s “Money Follows the Person” (MFP) and Balancing Incentives Program (BIP) Stakeholder Committee. Through involvement in the Committee, PAIR staff successfully advocated for the following program changes:a) Nursing facility residents who qualify for a Medicaid waiver will receive Options Counseling from an Independent Living Center, the local Area Aging Agency, or from both entities. This practice will provide a more person-centered explanation of program benefits than was previously provided. Options Counseling has been expanded from a conversation lasting approximately 15 minutes to a person-centered benefits review and in-depth explanation of options typically lasting more than an hour.b) Waiver application assistance will be provided the same day as Options Counseling to those who wish to apply. c) Peer-to-peer outreach and support contracts will provide a more robust relationship-building model for identifying and transitioning nursing facility residents who have not been served in the past. The contracts provide support for outreach workers who encounter barriers in working with individuals deemed incompetent by the facilities and, as a result of PAIR staff advocacy, outreach workers will no longer be prohibited from working with these individuals. Instead, outreach workers will be able to engage in communications to determine if the resident is able to express a choice about their options. PAIR staff also successfully advocated for the state-funded Peer Support contracts to include coordination with the Office of the Ombudsman for intervention on behalf of individuals who have been labeled incompetent by a nursing facility, have not been so adjudicated by a court, and have guardians that object to their learning about long term care options.

PAIR staff advocated for the state to re-prioritize its health care services registry to grant priority for receipt of services to individuals at risk of institutionalization rather than providing services based solely on the date of an individual’s application and place on the registry. The state has agreed to use federal funds available from the Balanced Incentive Program to provide standardized assessments and prioritize individuals on state waiver registries based on need. This change should assist people who remain in the community and have waited for years to access waiver services.

A case exemplifying how PAIR work affects individuals with disabilities follows:Ms. B. is 48 years old, had been in a nursing facility for six months and wanted to return home, but staff at the nursing facility told her she could not leave. Ms. B. is a wheelchair user who had been “certified incompetent” by the facility to make health care decisions. PAIR staff, in collaboration with our volunteer advocates, met with Ms. B. and her family and friends. Ms. B. agreed to a plan to safely return to her home. After eight months in a nursing facility, she moved back to her own apartment and married her fiancé of 4 years.

B. Litigation/Class Actions

1. Number of individuals potentially impacted by changes as a result of PAIR litigation/class action efforts15,000
2. Number of individuals named in class actions3

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.

PAIR staff continue to monitor implementation of the federal court Consent Decree, Bailey et al. v. Housing Authority of Baltimore City (HABC) and a separate settlement agreement with the City of Baltimore. This case was initiated as a class action on behalf of persons with disabilities who were applicants for or residents of public housing operated by HABC and who were denied: access to affordable, accessible housing; access to subsidized housing; or reasonable accommodations to enjoy the full benefits of the housing program. Plaintiffs include a person who was unable to use a bathroom for 19 years due to HABC’s failure to provide accessible housing in its public housing program. This Plaintiff could not go upstairs to her bedroom and the bedrooms of her children due to the inaccessibility of the unit. Her repeated requests to transfer were ignored. Another Plaintiff was a man who was homeless for years even though he should have been offered a subsidized housing unit based on his place on the HABC waiting list. HABC illegally restricted people with disabilities from leasing thousands of available housing units. The lack of stable housing and transient life style had negative consequences for his health and he had several hospitalizations related to his physical disabilities during the time he was living place to place. Another Plaintiff had requested reasonable accommodations in writing from HABC but never received a direct response to her request, which should have been granted.

Monitoring and implementation of the Consent Decree is a time consuming process requiring regular meetings of the parties, negotiations on various issues, and detailed document review. Negotiations can involve consultation with experts, clients or advocate organizations.

The Consent Decree requires HABC to make 5-7% of their approximately 10,000 public housing units accessible for persons who use wheelchairs and 2% of the units accessible for persons who have vision or hearing impairments.

As part of the Bailey Consent Decree, HABC set aside 1,350 vouchers for non-elderly persons with disabilities in need of a one-bedroom housing unit. Pursuant to the court order, HABC contracted with the Innovative Housing Institute (IHI) to assist persons who receive a voucher. IHI provides: assistance in finding and leasing a rental unit, security deposit and application fees, funds for utility hook up, and services for six months after a person leases a unit. To date, 1,318 people with disabilities have leased units though the IHI and the Enhanced Leasing Assistance program established by the Bailey Consent Decree.

The Consent Decree also requires that certain financial incentives be available to housing developers to stimulate development of affordable rental housing for people with disabilities on the HABC waiting list. As a result, 207 project-based subsidized rental units have been developed and are occupied by people with disabilities and another 297 are planned or in the production pipeline.

Of the 755 Uniform Federal Accessibility Standards (UFAS) units required by the Consent Decree, 625 are complete and were certified as UFAS accessible. Since the effective date of the Bailey Consent Decree, of the 685 public housing families on the accessible transfer waiting list, 410 families residing in public housing have transferred to UFAS units, and 39 have transferred to units with accessible features.

People needing accessible units also need accessible common areas. Pursuant to the Bailey Consent Decree, HABC is making sidewalks and curb ramps comply with federal accessibility guidelines. All of the identified 267 curb cuts identified for modification have been certified as compliant with accessibility standards. HABC has renovated or built 30 playgrounds on public housing sites to be UFAS compliant.

HABC has implemented a reasonable accommodation policy for its residents and applicants, as well as a policy by which residents with immediate needs can request and obtain modifications to their units or transfers on an expedited basis. 537 reasonable accommodation requests have been made to HABC by public housing residents. Requests include grab bars, raised toilet seats, hand held showers, a transfer to a different or larger unit to better accommodate the person, emergency strobe systems, a bench for a shower, lowered counter tops, lever handles on doors, and handrails. PAIR staff receives reports every six months that details the requests for accommodations and HABC’s responses.

As a result of the Consent Decree, HABC has trained its staff in fair housing obligations (with a continued obligation for training new staff). 39 staff were trained this past year and all were required to pass a test to demonstrate understanding of the training received.

Due to preferences established by the Bailey Decree, 597 applicants with a family member with a disability have moved off of the public housing waiting list and into public housing. In the past year, 65 residents of public housing requested transfers to an accessible housing unit and 39 residents transferred to accessible units. 51 housing units were modified by the HABC to provide vision or hearing accessibility this past year (e.g. flashing doorbells, strobe fire alarms). 200 people with disabilities leased units using a voucher and the services of IHI and the Enhanced Leasing Assistance program. 16 persons with disabilities renting units with housing vouchers requested modifications of their units and 14 persons received modifications paid for by funds set aside under the Bailey Consent Decree.

There have been approximately 680 immediate needs families identified. Families with immediate needs have meetings with HABC staff within ten days to determine the need and options for the family. This year, the Immediate Needs Team at HABC increased the number of home visits conducted per week to ensure that families receive a meeting within ten days. Immediate needs families receive transfers, a voucher, home modifications, or other temporary or permanent solutions.

The Consent Decree also required production of new opportunities through use of project based vouchers in new or rehabilitated developments. 91 persons with disabilities leased project based units in different private family rental developments during this grant reporting period.

As a result of monitoring new developments for accessibility compliance, PAIR staff noticed that a new housing development did not have accessible paths of travel to public bus stops. PAIR staff interviewed persons with physical disabilities at the new housing development and then complained to the property management. The issue was complicated by the need to involve Baltimore City, which owned some of the area and the Maryland Transit Administration (MTA) which would need to relocate some of the bus stops. After much negotiation, the development agreed to pour a new bus pad at one side of the development, the City agreed to put new accessible pads at other areas, and the MTA agreed to move their bus stops and signs to accommodate the new pads.

In an individual case, PAIR staff investigated when a client, a homeless veteran, told us that the Housing Authority reported he was not on the waiting list. He alleged he was being discriminated against due to his disability. We found that HABC had made errors in his information and PAIR staff assisted in getting him reinstated to the waiting list. Subsequently, his application was denied because he was temporarily living with his sister in Baltimore County, as he was otherwise homeless. We went to an informal hearing and successfully argued for HABC to give him the Baltimore City residency preference. The client was approved for housing. Without the benefit of housing legal services, this individual would remain homeless.

In another case, the health of both our client and her son had deteriorated. Due to her health conditions she could no longer pick her son up to move him from room to room. Her son’s condition required that he use a wheelchair most of the time and his housing was not accessible. Our client had 3 months left on her current lease. PAIR staff negotiated with the HABC and the landlord to permit our client to terminate her lease early and retain her housing subsidy so she could move to a more accessible housing unit, which PAIR staff helped her to locate.

In another individual case, PAIR staff represented a woman whose muscular sclerosis had progressed such that she was no longer able to leave her basement apartment and climb the steps to exit the building. She had a project based voucher and had not lived in the unit a year; however, PAIR staff successfully negotiated with HABC and the landlord to release her from her lease and provide her with a tenant based voucher so she could move to an accessible unit.

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.

MDLC envisions a world where people with disabilities are fully included in all aspects of community life. To move us toward this vision, our PAIR advocacy priorities include the protection of civil rights of persons with disabilities in public programs. Specifically, MDLC focuses on a) housing, b) transportation, c) access to community based health care services for people in nursing facilities, and d) access to school recreational activities.

a) Housing

1. PAIR priority: Expanding access to accessible and affordable housing and targeting discrimination so persons with disabilities can obtain or maintain such housing. This priority is accomplished through monitoring and implementation of the Consent Decree in Bailey v. Housing Authority of Baltimore City and individual case representation.

2. Need. A 2012 study released by the U.S. Department of Housing and Urban Development (HUD) demonstrates the correlation between rent burden and the incidence of disabilities based on HUD’s American Housing Survey. One finding of the study is that lower income households are much more likely to include one or more members with a disability than are high-income households. 30% of households with members having one or more disabilities are extremely low income, a rate that is three times greater than the percentage among households with extremely high incomes (9.8%). The study attributes this to the fact that one-third of all households with people with disabilities are single-person households and the earning potential of households, especially single-person households, is limited by having a member with a disability.

The study also demonstrated that rent-burdened households (those paying more than 30% of their income for rent) are significantly more likely than other households to include one or more residents with a disability. The proportion of households with one or more residents with a disability was 15% among households whose ratio of rent to gross income was 20% or less, that proportion climbed to 17.3% among households whose rent made up 30-40% of their total income. Among households whose rent exceeded their gross income, the incidence of disability was 27%. Households with a member with a disability are much more likely to live in urban areas than suburban areas (21.9% as compared to 15.3%). Additionally, residents with disabilities are more likely to be found in older homes: 19% of homes built between 1950 and 1969 had one or more member with a disability compared with only 13% of homes built after 1990. Finally, the percentage of households with members with disabilities is higher among those renters who live in subsidized housing (38.1%) than those living in market housing (14.5%).

A report issued by the Technical Assistance Collaborative, "Priced Out in 2012," documents that the HUD fair market monthly rent for a one-bedroom rental unit in Baltimore is more than the entire monthly Supplemental Security Income (SSI) benefit check issued to a person with a disability. A person with a disability relying on SSI would have to pay 164% of his or her monthly income to rent a modest one bedroom apartment in Maryland. Compared with other states, only Hawaii and the District of Columbia have higher rent burdens for people on SSI. People with disabilities who receive SSI payments continue to be the nation’s poorest citizens. In 2012, the annual income of a single individual receiving SSI payments was $8,436.00, which is equal to only 18.7% of the national median income for a one person household and is over 20% below the 2010 poverty level of $10,830. The value of SSI payments compared to median income has declined precipitously - from 24.4% of median income in 1998 to 18.7% in 2012 - all while national average rents have risen over 50% during this same time period. HUD has confirmed that non-elderly persons with disabilities face a worst case housing need based on the amount of income they are required to spend for housing.

In the Baltimore region, persons with disabilities are much more likely than persons without disabilities to live in poverty. In 2000, among all persons with a disability in the Baltimore region, 16.7% lived below the level of poverty, compared to 8.4% of persons without disabilities. In Baltimore County, 10.4% of persons with disabilities live in poverty compared to 5.4% of persons without disabilities who are living in poverty. In Baltimore City, 27% of persons with disabilities live in poverty compared to 20% of persons without disabilities who live in poverty. Baltimore City has a disproportionate number (27.5%) of persons who have a disability.

The economic reality is that persons with disabilities on fixed incomes need a subsidy to be able to rent a place to live. Yet they face a critical lack of affordable and accessible housing. As of December 2011, there are a total of 32,597 people on the Housing Authority of Baltimore City’s (HABC’s) waiting list for subsidized housing. HABC provides subsidies through the provision of vouchers and public housing units. Almost 40% of the subsidized housing waiting list is comprised of non-elderly persons with disabilities, and 98% of the households waiting for public housing have incomes below 30% of the area median income. 54% of people on the HABC waiting list for subsidized housing need one-bedroom units.

The need for accessible housing is indisputable. The Baltimore City Consolidated Housing Plan and the Baltimore City Housing Authority Annual and Five Year Plan identify the lack of accessible housing as an issue for the region. In Baltimore County, the County’s Analysis of Impediments (2011) and the County’s 2013 fiscal year Annual Action Plan both report the need for more accessible housing in the County. The Mayor’s Commission on Disabilities in Baltimore City and the Baltimore County Commission on Disabilities have both identified the lack of accessible housing as a major problem for people with disabilities. The regional study of impediments to fair housing identified the lack of accessible housing as a barrier for people with disabilities in the entire Baltimore metropolitan area. Baltimore City’s housing presents special challenges as it is home to the largest concentration of poor people in the state, including a large concentration of persons with disabilities, but is a City replete with row houses, which poses significant challenges to accessibility. The City’s public housing stock was not accessible and was one of the causes of action in the Bailey lawsuit. PAIR staff discovered that the Housing Authority had identified over 900 of public housing units as accessible in reports to the federal government, but after further analysis it was determined that only one housing unit was fully accessible out of a housing stock of over 10,000 units. Baltimore County offers no public housing thus there is no County owned subsidized housing stock that must offer accessible units to persons who use wheelchairs. The affordable family rental housing in the County was developed prior to the passage of the Fair Housing Act, thus even the less rigorous requirements for access offered by the Fair housing Act do not provide accessible housing opportunities for low income renters in Baltimore County. Baltimore County is also home to a significant number of people with disabilities. In the County, over 18% of individuals are reported to be people with disabilities. Approximately half of the persons on the County housing choice voucher waiting list have disabilities. A third of voucher holders are persons with disabilities. The waiting list for a voucher in the County is estimated to be 8-9 years. Over 90% of persons on the Housing Choice voucher waiting list are estimated to have incomes below 30% of the area median income. The need for affordable housing for persons with disabilities is severe.

Compounding the shortage of affordable and accessible housing is the fact that both Baltimore City and Baltimore County have lost significant units of low income housing in the past decade, which have not been replaced. In contrast, between 2000 - 2008, over 27,000 high-rent units were added to the housing stock in Baltimore City and 45,000 in Baltimore County. These two jurisdictions also experienced the largest declines in affordable units renting for $500 or less. A 2007 report estimates that the number of occupied HABC units dropped 42% in 15 years, from 16,525 units in 1992 to 9,625 in 2007. The effect of the loss of affordable or subsidized housing units is devastating. The loss contributes to homelessness, instability, more restrictive living environments, and worsening of health conditions. Providing housing will increase stability, productivity and promote the human rights of persons with disabilities.

3. Outcome Indicators. One indicator of the success of the Bailey Consent Decree was its mention in a report, “Baltimore Metropolitan Area Analysis of Impediments to Fair Housing Choice”, wherein the Bailey Consent Decree was given credit for being the impetus for development of affordable housing for people with disabilities. The report stated that the Bailey Consent Decree has shaped the fair housing landscape by increasing the availability of affordable and accessible housing. Other indicators of success include the following:

i. There has been an increase in the number of persons with disabilities using both housing vouchers and leasing public housing in Baltimore City as a result of the Bailey Consent Decree (1,318 voucher units leased to persons with disabilities and 597 families with disabilities moved into public housing)

ii. Over 535 families in public housing requested and received responses to their requests for reasonable accommodations

iii. There has been an increase in the number of accessible public housing units in the City (625 units)

iv. More common areas, including sidewalks, management offices, and playgrounds have been made accessible (30 playgrounds, 276 curb cuts)

v. More hard rental housing units have been developed and are available to extremely low income persons with disabilities (207 project based units)

vi. Two large housing developers changed their application processes, altered discriminatory practices and provided more due process in their tenant application and selection procedures

vii. Two property management companies altered their practices and provided reasonable accommodations so applicants or tenants with disabilities could become tenants or maintain tenancy

viii. The rights of tenants in project based housing units were protected so they retain eligibility for the housing choice voucher tenant based program.

4. Collaboration. PAIR staff collaborates with the U.S. Department of Justice which represents the United States as co-counsel in the Bailey case. PAIR staff collaborate with several other legal service providers that have an interest in housing (Homeless Persons Representation Project, Legal Aid Bureau, Public Justice Center, ACLU) to keep one another informed about issues related to housing services in Baltimore City and coordinate on policy reforms. The legal service advocates, including PAIR staff, have monthly meetings with the Baltimore City Housing Commissioner to discuss common issues or concerns. PAIR staff take part in the National Low Income Housing Coalition’s Housing Justice Network, where we are able to dialogue with legal services providers across the country on local and national issues affecting our clients. PAIR staff has been appointed to serve on the State Department of Disabilities’ (DOD’s) Commission on Affordable Housing. PAIR staff is a Commissioner for the Department of Disabilities Advisory Committee and chaired the Commission’s State Plan Subcommittee, which made recommendations related to creation of affordable, accessible and visitable housing for persons with disabilities. PAIR staff participates in the advisory committee of the National Low Income Housing Coalition. Significantly, PAIR staff have collaborated intensively with co-counsel from the ACLU, NAACP, Public Justice Center and Legal Aid in filing an Administrative Complaint to HUD against Baltimore County and the County Housing Office. PAIR staff represent two clients with disabilities who use vouchers but cannot locate any accessible housing units in the County. The Administrative Complaint is in conciliation and a parallel investigative process is ongoing. The processes require multiple meetings and legal work. One of our PAIR clients attends all conciliation meetings. Both clients participated in meetings with HUD investigators to describe in detail the discrimination they faced and how that discrimination affected their lives and that of their children.

5. There were 84 housing cases handled under this priority in addition to the continued monitoring and implementation of the Bailey Consent Decree and the administrative investigative and conciliation processes involved in the Baltimore County Administrative Complaint.

6. Case examples. An individual called to discuss her housing situation with PAIR staff. The caller had suffered a stroke and had a brain tumor. She uses a wheelchair due to the effects from her stroke. She was living in a rental unit which had been foreclosed and she needed to move. PAIR staff were aware of a new tax credit property that, due to the Bailey Decree, had developed more than the minimal number of federally required accessible units. PAIR staff assisted the client to obtain a voucher and then negotiated to have the special requirements of that voucher waived so she could move into the accessible unit. PAIR staff also negotiated with the landlord to accept the client after her rental application was denied due to prior debts and poor credit, which PAIR staff related to her disability and medical needs.

In another case, we represented a man with psychiatric and physical disabilities who had been requesting a live-in aide from his property manager in public housing. When the client told the property manager that he needed someone to stay with him overnight due to his uncontrolled diabetes and physical limitations, he was told that if he needed overnight assistance he belonged in assisted living. We assisted the gentleman in requesting a live-in aide as a reasonable accommodation and settled the case with the Housing Authority on terms favorable to our client.

In another case, PAIR staff assisted two brothers, one in his mid 70s and the other in his mid 80s, who have hearing impairments and rely on one another for communications and companionship. The clients were living in a building where the elevator was frequently broken and they could not navigate all the steps to their apartment. They wanted to move, but to remain near to one another. They were in the middle of their lease and on a waiting list for a newer apartment complex with better services. PAIR staff were able to convert their lease to a month to month tenancy and then helped them to obtain units next door to one another in a newer apartment complex. This entailed negotiating with the new property manager to waive an element of their screening criteria to accept one of the brothers.

b) Transportation

1. PAIR priority: Expanding access to reliable public transportation service. Persons with disabilities must be able to rely upon public transportation to meaningfully participate in community life. The Baltimore Metropolitan paratransit service must operate without capacity constraints and offer service that is comparable to the public bus system.

2. Need. Persons with disabilities who are unable to use the public bus system must have an alternative public transportation system on which they can rely. When PAIR staff sued the Maryland Transit Administration (MTA) paratransit system on behalf of riders in 2004, the system was “dysfunctional” according to the Secretary of the Maryland Department of Transportation. PAIR staff had tried to work with MTA for several years prior to filing a lawsuit. PAIR staff processed over one thousand individual complaints from riders and forwarded written complaints to MTA. After failing to resolve the issues with MTA, PAIR staff forwarded the complaints to the Federal Transit Administration and requested a compliance review of MTA’s paratransit service. After the FTA made findings of noncompliance and more time passed without major changes in the system, PAIR staff filed a lawsuit. The lawsuit detailed the need for reform. Clients were left stranded for hours when paratransit vehicles did not pick them up as scheduled. Over 600 clients a month were reported stranded when a vehicle did not come at a scheduled pick up time. Clients were left waiting outside in inclement weather resulting in illness and hospitalization. Clients reported missing dialysis and other medical appointments. Other clients reported missing school and even exams due to late rides, and losing a job due to repeated late arrivals. A client was kept on a vehicle for over five hours without a bathroom stop. Clients reported that they could not rely on the system and therefore limited their daily life activities. Many clients reported being isolated at home because of the inability to rely on the paratransit service. Many paratransit riders have fixed, limited incomes and almost all have no alternative method of transportation.

While the lawsuit ended in 2011, the MTA asked PAIR staff if they would continue their regularly established meetings with MTA officials. A group of PAIR clients had served for numerous years as Class Representatives during the litigation, settlement, implementation and monitoring work related to the lawsuit. This process has continued throughout this reporting period. PAIR staff continue to obtain data from MTA, and to learn from clients and others with disabilities about problems with paratransit service. MTA and PAIR clients work together to solve problems related to late rides, trip times, problems accessing the service, and vehicle or customer service issues. The need for the service can be demonstrated by its demand. Compared with other modes of transportation, including bus, light rail, MARC train, contracted commuter bus or Metro service, the paratransit system is the only service to sustain double didgit growth in demand over the past five years. There are approximately 20,000 certified riders of paratransit service, an all time high number of riders. The service provides nearly 2 million rides a year. The continued growth in demand has put a stress on the service system making the communications between PAIR clients and MTA officials essential for maintaining the service enhancements achieved by the litigation.

3. PAIR staff review data related to partransit on-time performance, telephone hold time, trip length and missed trips to monitor the outcome of the service. In addition, PAIR staff surveyed over fifty riders at a forum on paratransit services to learn of their concerns with the service. On-time performance maintained at close to 90% during this reporting period. Trip time did not significantly increase after run adjustments were made. There were numerous issues with the call lines including the reservation line, certification line, and late line. PAIR staff received multiple complaints from clients and riders about rude customer service and problems with faulty vehicles. Regarding problems with the phones, MTA undertook a study of their phone system and concluded that they needed a new telephone system. The phone system is expected to be replaced next fiscal year and should have a significant impact on issues related to hold time and dropped calls. MTA has agreed to use a call system that identifies how long the expected hold time is for callers. MTA also undertook a study to review the type of vehicle best suited for service. PAIR clients have maintained for years that the large mini-buses used for much of the service are inefficient. MTA has agreed to replace these buses with new sedan vehicles that were shown to PAIR clients and are highly regarded. These vehicles are much smaller, will provide smoother service and limit the number of passengers per trip, providing more direct routes for trips. The vehicles are more cost efficient and better for navigating many of Baltimore’s one way streets as they can permit loading and discharge from both sides of the vehicle.

MTA obtained extra financial resources to put more personnel into its customer call center which has helped but did not fully solve the problem of long telephone hold times. MTA then agreed to extend call center hours from 5:00 pm to 7:00 pm to give customers expanded opportunities to call into the service and reduce the demand during the end of each day. Other changes in policies that demonstrate the success of work in this priority area are detailed in Part IV. above and are incorporated by reference herein.

4. Collaboration. Pursuing the transportation priority requires collaboration with former class representatives, riders, and MTA. In addition, PAIR staff consult with community service providers who advocate for people with disabilities to learn more about problems in the paratransit system. PAIR staff provided fliers to several kidney dialysis centers to inform staff and riders that if they were losing paratransit services they could contact MDLC. PAIR staff also collaborated with the League for People with Disabilities in conducting a forum for riders to discuss their concerns and learn about their rights to paratransit service. The League for People with Disabilities is a large provider of rehabilitation services in Baltimore City. PAIR staff receive complaints from riders and forward them to MTA officials to review the responses and keep informed of issues. These communications with riders are not opened as case services and are not reflected in the case numbers submitted in this report.

5. PAIR staff shared 12 written complaints from individual riders with MTA and handled 4 cases. Our focus was not individual complaints but to gather information and concerns from riders and negotiate system issues with MTA officials. We had no class action activity.

6. PAIR staff investigated a client’s concern that she was no longer able to use paratransit services. In this case, the client was living in an assisted living facility where she was able to get paratransit services three times per week (6 trips per week) for dialysis treatments. The client wished to return to her home but was informed that she would no longer be eligible for paratransit service, and she had no other transit options. She is a retired teacher and ineligible for Medicaid yet not able to afford the cost of taxi services for dialysis which would cost her nearly five hundred dollars per month ($20.00 each trip). PAIR staff negotiated with MTA regarding the client’s situation, her limited income, and the fact that the dialysis center is not far from her home. MTA agreed that the client is able to use paratransit service from her home.

c) Nursing Facilities

1. Nursing facility residents who have disabilities must be provided effective information about their options for living in the community and have access to appropriate Medicaid waivers and other programs designed to facilitate their movement to high quality, community-based services.

2. Need. Nationally, Medicaid is the primary payer for two-thirds of nursing facility residents, financing over 65% of nursing facility long term care costs. Serving persons with long term care needs through Medicaid funded community services will reduce health care expenditures, is consistent with the desires of individuals with disabilities, and is consistent with civil rights laws. Maryland’s percentage of expenditures on long term care institutional services remains well above the national averages. Although most individuals prefer to receive their long term services and supports in their own home rather than in nursing facilities, Maryland spends 85% of its long term care dollars on facility stays, and 15% on home and community based services for people who are aging and/or disabled.

Despite state efforts, there has not been a significant shift from Medicaid long term care expenditures for nursing facilities to expenditures for persons receiving Medicaid funded in-home and community based services. Maryland ranks among the ten worst states comparing the ratio of institutional with community long term care dollars spent on older adults and persons with physical disabilities. Comparing the number of home and community based service participants per 1,000 persons among the states, Maryland ranks even worse. From 2004 - 2009, most states made progress towards less reliance on nursing facility care for older adults and persons with physical disabilities; however, Maryland lost ground. Maryland must make real change to ensure that those individuals who wish to live in the community are not forced into or remain in nursing facilities to receive health care services. Diversion of persons from nursing facility long term care is the most efficient and cost productive method of saving on Medicaid long term care costs. Unfortunately, Maryland’s system of Medicaid services is not designed to keep people out of nursing facilities. For example, the 2010 and 2011 Kaiser Commission Annual Reports on Medicaid programs demonstrate the relative inadequacy of Maryland’s personal care services. Of the thirty-three states opting to provide personal care services, Maryland’s rate appears to be the lowest. With one exception, the other states listed have an hourly rate ranging from $9.39 to $63 per hour with the average Medical Assistance Personal Care (MAPC) rate being $17.60 an hour. Maryland is listed as having a $33.98 per day rate and Louisiana has a rate of $214.87 per visit. With the one exception, Maryland appears to be the only state not to base personal care on hourly rates. Maryland needs to change the current reimbursement system and establish an hourly rate sufficient to allow people with significant disabilities to remain at home or in their communities rather than a nursing facility or institution.

3. Indicators. Indicators of success include: increased outreach to persons in nursing facilities to ensure that they learn about their right to use Medicaid funds for care in the community, policy changes so more community services are available, and movement of individuals from nursing facilities into the community. These indicators were met as evidenced by the following: The "Sunshine Folk", peer volunteer advocates recruited and trained by PAIR staff, provided outreach to 300 individuals in nursing facilities. The "Sunshine Folk" also identified individuals in nursing facilities who had not received information about their community living alternatives and ensured that they were informed of their rights. PAIR staff provided technical assistance to the "Sunshine Folk" as they supported 20 individuals in transitioning from nursing facilities to their own homes in the community. PAIR staff also trained individuals under contract with the Independent Living Centers to provide peer outreach to nursing facility residents, a model based on the "Sunshine Folk" project. PAIR staff supported a change to the state’s peer outreach model contract so that mentorship from peers continues through the first year after the resident’s transition to the community.

4. Collaboration. PAIR staff collaborated with the following organizations to increase community options for persons in nursing facilities: the Brain Injury Association of Maryland; Legal Aid Bureau, Inc.; the Image Center; Independence Now; Friends and Family Ties-Shared Supports; The Coordinating Center; Maryland ADAPT; and the Department on Aging Statewide Long Term Care Ombudsman.

5. PAIR staff worked on two cases of individuals in nursing facilities who wanted to leave the facility and move home to the community. PAIR staff also trained and provided technical assistance to the Sunshine Folk who assisted 20 individuals in transitioning from facilities to the community.

6. Case examples. PAIR staff met an individual at a nursing facility who wanted to leave and return to the community, but believed he could not sign the necessary documents. We reported last year about his triumphant first step toward independence when he signed his first document to engage PAIR staff to help him transition. The transition process was slow and complicated, but the gentleman is finally in his own apartment. He reports, "I’m happy and glad I did this. I’m treated like a man and wear clothes now. My room is beautiful and mine."

PAIR staff intervened to assist a 33-year-old nursing facility resident gain access to the Home and Community Based Waiver. The PAIR client had been denied the opportunity to apply for the waiver because he was not on Medicaid Long Term Care. He was eligible, but the state was not processing applications timely and his was months delayed. PAIR staff raised this issue with state officials and wrote letters on the client’s behalf, and he was provided with the right to apply and then receive waiver services; as a result, he moved back into the community.

d) School Athletics and Recreational Programs

1. Priority. Expanding Access to Participation in School and Fitness Activities. Increasing opportunities for students with disabilities to participate in school-based fitness and athletic activities including after school activities is a PAIR priority. Monitoring of the 2008 Fitness and Athletic Equity Act for Students with Disabilities and collaborating with staff who work with providers of out of school activities for students addresses this priority.

2.Need. Physical activity is significant to the health and emotional well-being of children with disabilities. Childhood obesity is a health epidemic. Studies demonstrate that individuals with disabilities are three times more likely to be sedentary than individuals without disabilities. Fifty percent of persons with disabilities report that they engage in no meaningful physical exercise. The Surgeon General has confirmed that physical activity reduces the risk of heart disease, high blood pressure, diabetes and other illness. In addition, studies confirm that students who participate in school based athletic programs are more likely to graduate, have increased academic success, and develop stronger self-confidence compared with students who are not participants. Further, including students with disabilities in physical activity provides opportunities for other students to see that people with disabilities have strength and abilities. A few years ago, PAIR staff represented a young woman who was a paralympic athlete in track and field but was denied the opportunity to participate on her high school track and field team because she uses a wheelchair. After unsuccessful attempts at negotiation with the school system, PAIR staff filed a federal lawsuit to protect the interests of the student. Her rights were vindicated in federal court and created a stir of publicity which generated public interest in this issue. PAIR staff heard from many people and co-founded the SPARK Coalition to discuss methods for including students with disabilities into school-based physical activity. Despite evidence of the importance of physical activity for youth in general and for children with disabilities in particular, a survey of Maryland’s 23 county school systems and Baltimore City schools found only 3 jurisdictions reported having policies or guidelines related to the participation of students with disabilities in athletics. A state task force (on which PAIR staff participated) found that a lack of policies and accountability for the participation of students with disabilities in Maryland’s schools is a barrier to their participation in physical education and athletic programs. A separate study surveyed 115 public high schools in Maryland, Virginia and Pennsylvania over several years and found that only 11 students with disabilities were provided accommodations in athletic programs, and only two schools reported having any written policies about including students with disabilities. In 2008, PAIR staff led a coalition of organizations that advocated for new opportunities for students with disabilities. As a result of advocacy efforts, Maryland passed a law requiring schools to provide equal opportunities for students with disabilities to participate in physical education and athletic activities and to be included with students without disabilities.

3.Indicators. The following outcomes demonstrate the success of efforts on this priority: According to a report filed with the Maryland General Assembly by the Maryland State Department of Education (MSDE) in August 2012, all but one school system has adopted policies to accommodate students with disabilities in school athletic opportunities and in physical education. All school systems submitted plans to MSDE for including all students in physical education. All school systems have submitted plans to MSDE demonstrating development of new sports programs in each of the three sports seasons of fall, winter and spring. These programs are required to include students with and without disabilities. Last year, over 5,200 students participated in such new opportunities, an increase of over 2,000 students from the previous year. Slightly over half of such students were students with disabilities who have individualized (IEP) or Section 504 education plans. Supplementing this outcome is the publication, developed by MDLC with contributions of PAIR staff, entitled, "Together Beyond the School Day: Including Youth with Disabilities in Out of School Time Programs." The brochure is available for parents, students, providers of out of school time programs, teachers and others. The publication, developed with PAIR staff time and collaboration, is posted on MDLC’s website and has been distributed widely.

4. Collaboration. PAIR staff collaborated with individuals associated with the Maryland Out of School Time (OST) Network to discuss training and collaboration on inclusive after school activities. The Maryland OST Network is a broad based coalition working to increase the quantity and quality of afterschool and summer opportunities for young people across the state. PAIR staff identified the need to raise awareness and training so students with disabilities were welcomed and included in out of school time opportunities. As a result of these meetings, MDLC agreed to develop a resource booklet that would provide information about the rights of students with disabilities to be included in such opportunities and identify ways that inclusion can be provided. With other funding, MDLC staff provided training and technical assistance to several out of school time programs and presented at the annual OST state conference, the Baltimore City PTA Health Fair, and to the CityWide Special Education Advocacy Project (a coalition of over 40 service providers and parents of students with disabilities).

5. Cases. PAIR staff did not handle individual cases under this priority.

6. Case example. PAIR staff did not handle individual cases under this priority.

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. MDLC’s areas of advocacy for PAIR staff include access for persons with disabilities to: affordable and accessible housing; reliable transportation; community based services for persons in nursing facilities; and educational and recreational programs for youth.

2. The need addressed by each priority is stated separately in Part V. A. 2. above.

3. Activities to implement the priorities include the following:

a. Access to Affordable and Accessible Housing and Non-Discrimination in Housing:

i. Continue to monitor implementation of the federal court Consent Decree in Bailey et al. v. Housing Authority of Baltimore City (HABC). The lawsuit alleged that HABC discriminated against people with disabilities by refusing to allow them to live in certain housing, make public housing accessible, and provide reasonable accommodations. Current emphasis is on negotiations to obtain the Decree remedies to: create project based and long term affordable housing opportunities for non-elderly persons with disabilities, provide timely accommodations, and develop accessible housing.

ii. Individual case representation on issues relating to alleged discrimination in housing programs.

iii. Continue negotiations and investigations through the HUD administrative process to obtain creation of accessible housing in Baltimore County, Maryland. PAIR clients who need accessible and affordable rental units in Baltimore County were unable to locate such housing in that jurisdiction. Clients who need accessible units and have vouchers in the County are forced to live in inaccessible housing and the voucher program could not identify any accessible units to which they could apply to live. Baltimore County offers no public housing. In addition, the subsidized housing and housing that accepts vouchers is located in areas of high crime, high poverty and high minority concentration. These areas generally provide little job opportunity and have poor performing schools. Part of the remedy being sought in the HUD Complaint is for housing that is affordable, accessible and available in neighborhoods with better opportunity. Other remedies include: an assessment of people needing accessible units, changes to the County housing application, creation of a modification fund, and creation of a program to help voucher holders use the voucher to lease units in areas of opportunity.

iv. Outreach to Baltimore Neighborhoods Inc. and an Independent Living Center to collaborate on increasing affordable and accessible housing for persons with disabilities.

b. Access to Equal Opportunity in Transportation:

i. Continue to meet with PAIR clients who use paratransit service and MTA officials to resolve service problems and advocate for service enhancements.

ii. Ensure that riders get better information about paratransit changes and the Taxi Access service.

iii. Work with MTA to improve its certification/re-certification process.

iv. Advocate for improved telephone service and ride notice for riders.

v. Forward individual rider complaints to MTA.

vi. Identify opportunities to increase support for transportation related initiatives.

c. Access to Community Based Services for Nursing Facility Residents:

i. Support the "Sunshine Folk", volunteer peer mentors who provide information to nursing facility residents about health care options and rights, targeting facilities that have poor quality ratings and low-income residents.

ii. Participate in workgroups implementing federal grants to the state to increase availability of community funds and options for persons in or at risk of institutional placement and monitor federal grants and waiver programs to identify barriers or support policy changes that will assist persons wiht disabilities to receive needed health care while living in the community

iii. Develop a brochure for nursing facility residents describing the experiences of individuals who have transitioned from facilities to their communities and providing resources and contact information.

iv. Provide technical or legal assistance for a few individual residents to assist with their transitions to the community.

v. Provide training to the Independent Living Center’s peer-to-peer program for nursing facility residents.

d. Access to Educational and Recreational Opportunities:

i. Obtain admission to camp for a youth who has been excluded based on her potential need for staff to administer Diastat. PAIR staff assisted a parent in filing a complaint with the Department of Justice after a camp program refused to allow a child to attend. The child’s doctor provided a letter stating that she is medically appropriate to attend camp, the Epilepsy Foundation agreed to provide a free training video for camp staff and officials, and the child’s parents agreed to sign a waiver to permit emergency administration of Diastat. After seemingly successful negotiations, the camp refused to admit the child; thus PAIR staff will continue to work with the family and the Department of Justice to resolve this matter and to achieve a policy change so that other youth with disabilities can be accommodated.

ii. Produce a manual on the educational rights of students with disabilities as required by Section 504 of the Rehabilitation Act. This past fiscal year, PAIR staff provided case services to students from different jurisdictions and with different disabilities but with similar issues related to improper identification of disability and inadequate provision of services to permit the students to benefit from their educational environment. A resource for families, advocates and educational personnel will provide a needed tool for better understanding and implementing the rights of students with disabilities. This activity will involve collaboration with other MDLC special education staff.

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



BUDGET PERIOD: 10/1/2011 THROUGH 9/30/2012

A. Sources of funds received and expended

Source of Funding Amount Received Amount Spent
Federal (section 509)279,768315,850
Program income40,24440,244
All other funds51,38351,383
Total (from all sources)320,012407,477

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

Category Prior Fiscal Year (FY 2012) Current Fiscal Year (FY 2013)
Wages/ salaries279,942256,646
Fringe benefits66,39151,902
Materials Supplies3,3121,000
Rent & occupancy costs20,9575,000
Travel2,1871, 500
Equipment (rental)3,707500
Expert fees (interpreter)1615,000
Computer consultant10,6472,500
Record Fees604600

C. Description of PAIR Staff

Type of Position FTE % of Year Filled Person-years

PAIR duties for attorney staff include providing individual case representation; outreach and training; public policy work; supervision of paralegal staff; professional development; working wiht client based coalitions; and class action litigation as applicable. PAIR duties for paralegal staff include intake screening and follow up; provision of informaiton and referral services; outreach; individual case work assistance; following supervision of attorney; professional development; support for projects such as nursing facility "Suhshine Folk".

D. PAIR staff is involved with the following advisory committees:

Commissioner for the Commission on Disabilities, a body comprised of Gubernatorial appointees that advises the State Department of Disabilities (DOD). The Commission meets monthly to provide advice to the Secretary of DOD on matters of importance to Marylanders with disabilities.

Member of the DOD housing task force. The task force meets to discuss the lack of affordable and accessible housing for persons with disabilities and to develop policy initiatives.

Chair of the State Plan Subcommittee of the Commission for People with Disabilities.

Member of a coalition of legal service providers and housing advocates for homeless persons, including ACLU, Homeless Persons Representation Project, Maryland Legal Aid Bureau, and University of Maryland School of Law Clinical Program. This coalition meets regularly with the Commissioner of the Housing Authority of Baltimore City.

Member of the National Low Income Housing Coalition Advisory Committee

Board member of the Statewide Independent Living Council.

Member on the Department of Health and Mental Hygiene Living at Home Waiver Advisory Board.

Member of the Department of Aging Options Counseling Pilot Development Team

Board member of the Statewide Independent Living Council.

Member of the Statewide Long Term Care Ombudsman Stakeholder’s Committee

E. Grievances filed under the grievance process: None.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: MDLC has a long-standing relationship with the Client Assistance Program and will routinely make appropriate referrals to that office. In addition, PAIR staff was appointed to the Statewide Independent Living Council (ILC) and serves with the Director of the Client Assistance Program, which enhances the relationship between the programs.

PAIR staff coordinates with both the State and local Ombudsman programs. One example of the collaboration relates to the Long Term Care Ombudsman Stakeholder Committee. The Committee advises the Department of Aging on long term care reforms. PAIR staff provide support to a former nursing facility resident who serves on the Stakeholder Committee so he can be fully involved in providing input.

PAIR staff and the Statewide Ombudsman meet bi-monthly to review progress or barriers to rebalancing Maryland’s long term care institutional bias and discuss conditions within nursing facilities. PAIR staff worked closely with the Ombudsman program on behalf of nursing facility residents in a particular facility who had suffered abuse, neglect and transition obstructions. The State closed the nursing facility during this report period. Each resident was either transferred to another facility or received an accelerated transition to the community. PAIR staff train and work with volunteer advocates that are former nursing facility residents, the Sunshine Folk, who monitor some of the individuals that were transferred to other nursing facilities. For those individuals who are interested in transitioning to the community, the volunteer advocates are facilitating that process. The Ombudsman has asked the Sunshine Folk to train residents about their rights with support from PAIR staff. PAIR Staff and the Statewide Ombudsman have a close relationship regarding each other’s advocacy roles and consult often on individual cases. PAIR staff and local ombudsmen make frequent referrals to one another. The Sunshine Folk have also been asked to train new ombudsmen.


Signed ByVirginia Knowlton Marcus
TitleExecutive Director
Signed Date12/10/2012