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

Massachusetts (DISABILITY LAW CENTER, INC.) - H240A130022 - FY2013

General Information

Designated Agency Identification

NameDisability Law Center
Address11 Beacon Street Suite 925
Address Line 2
CityBoston
StateMassachusetts
Zip Code02108
E-mail Addressmail@dlc-ma.org
Website Addresshttp://www.dlc-ma.org
Phone617-723-8455
TTY 617-227-9464
Toll-free Phone800-872-9992
Toll-free TTY800-381-0577
Fax617-723-9125
Name of P&A Executive DirectorChristine M. Griffin
Name of PAIR Director/CoordinatorChristine M. Griffin
Person to contact regarding reportChristine M. Griffin
Contact Person phone617-723-8455
Ext.146

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 areas43
2. Individuals receiving I&R outside PAIR priority areas10,647
3. Total individuals receiving I&R (lines A1 + A2)10,690

B. Training Activities

1. Number of trainings presented by PAIR staff15
2. Number of individuals who attended training (approximate)4,800

C. Information Disseminated to the Public

1. Radio and TV appearances by PAIR staff6
2. Newspaper/magazine/journal articles4
3. PSAs/videos aired0
4. Hits on the PAIR/P&A website17,324
5. Publications/booklets/brochures disseminated37
6. Other (specify separately)92

Narrative

DLC attorneys and advocates provide a significant amount of non client technical assistance to professionals and other advocates on disability rights issues. This is important work and worth the resources to ensure that others are capable of advocating for an individual and groups of people with disabilities. DLC also has an opportunity to impact disability policy statewide since a number of non client technical assistance is provided to state agency and legislative staff.

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)8
2. Additional individuals served during the year72
3. Total individuals served (lines A1 + A2)80
4. Individuals w. more than 1 case opened/closed during the FY. (Do not add this number to total on line A3 above.)5

B. Individuals served as of September 30

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

C. Problem Areas/Complaints of Individuals Served

1. Architectural accessibility2
2. Employment21
3. Program access11
4. Housing10
5. Government benefits/services1
6. Transportation2
7. Education31
8. Assistive technology1
9. Voting0
10. Health care3
11. Insurance0
12. Non-government services0
13. Privacy rights0
14. Access to records0
15. Abuse2
16. Neglect1
17. Other0

D. Reasons for Closing Individual Case Files

1. Issues resolved partially or completely in individual favor44
2. Other representation found1
3. Individual withdrew complaint6
4. Appeals unsuccessful1
5. PAIR Services not needed due to individual's death, relocation etc.0
6. PAIR withdrew from case0
7. PAIR unable to take case because of lack of resources0
8. Individual case lacks legal merit7
9. Other0

Please explain

E. Intervention Strategies Used in Serving Individuals

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

1. Technical assistance in self-advocacy0
2. Short-term assistance61
3. Investigation/monitoring1
4. Negotiation7
5. Mediation/alternative dispute resolution0
6. Administrative hearings0
7. Litigation (including class actions)0
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 - 42
2. 5 - 2227
3. 23 - 5944
4. 60 - 643
5. 65 and over4

B. Gender of Individuals Served

Multiple responses not permitted.

1. Females44
2. Males36

C. Race/Ethnicity of Individuals Served

For individuals who are non-Hispanic/Latino only

1. Hispanic/Latino of any race7
2. American Indian or Alaskan Native2
3. Asian0
4. Black or African American7
5. Native Hawaiian or Other Pacific Islander0
6. White64
7. Two or more races0
8. Race/ethnicity unknown0

D. Living Arrangements of Individuals Served

Multiple responses not permitted.

1. Independent28
2. Parental or other family home44
3. Community residential home0
4. Foster care0
5. Nursing home3
6. Public institutional living arrangement0
7. Private institutional living arrangement0
8. Jail/prison/detention center4
9. Homeless1
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 impairment5
2. Deaf/hard of hearing11
3. Deaf-blind1
4. Orthopedic impairment15
5. Mental illness1
6. Substance abuse1
7. Mental retardation0
8. Learning disability15
9. Neurological impairment2
10. Respiratory impairment2
11. Heart/other circulatory impairment1
12. Muscular/skeletal impairment6
13. Speech impairment0
14. AIDS/HIV0
15. Traumatic brain injury0
16. Other disability20

Part IV. Systemic Activities and Litigation

A. Systemic Activities

1. Number of policies/practices changed as a result of non-litigation systemic activities2

2. Number of individuals potentially impacted by policy changes100,000

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.

DLC staff are involved in a number of systemic activities funded in whole or in part with PAIR grant dollars. These activities include filing amicus briefs, advocacy and trainings. It is difficult to predict how many people will be or could be impacted by this work and so the number listed in the 2 block above is a very conservative estimate. For number of policies and practices that have actually changed as a direct result of our work we know that is 2 and therefore our estimate on individuals and their families impacted by those changes is what we estim submitted. However, it is not difficult to expand that estimate greatly if you include the ripple impact that our trainings, advocacy and amicus brief impact will have on all people with disabilities and their families in Massachusetts and beyond.

Hollister Amici Brief There are more than 500 Hollister clothing stores in the United States and 15 of them are in Massachusetts. Although built in indoor malls, Hollister built their stores with an inaccessible main entrance that resembles a porch with stairs. The accessible entrances are at mall floor level but hidden as shuttered entrances, with plants placed in front of the accessible entrances making it difficult to determine how to access the store if you have mobility impairments. A complaint was filed with the Massachusetts Architectural Access Board (AAB) and the AAB’s decision that all entrances must be accessible was appealed by Hollister to the Massachusetts Supreme Judicial Court. DLC was asked by the AAB to file an amicus brief in this case and the SJC also asked for the filing of amicus briefs on question of whether the inaccessible porch entrance to Hollister stores and the two accessible side entrances is one entrance or three entrances. DLC staff held a variety of meetings and conference calls to discuss our position on this issue and to find other advocacy groups that agreed with our position and would like to participate as amici on the brief that DLC would write and file. DLC draft a brief dealing with 4 issues: 1) General support for the AAB on the question of whether there was one or multiple entrances; 2) Examination of a legal argument, not discussed by the parties briefs, that all public entrances must be accessible and not interrupted by steps, and therefore the stores did not comply with the code no matter whether it was one entrance or multiple entrances; 3) Social science literature from fields of retailing and marketing about effects of segregation and exclusion on shoppers with disabilities and 4) Economic benefits to retailers from providing good access; market power of people with disabilities; universal design and tendency of retailers to overestimate costs and underestimate benefits of access. The brief was filed on 9/20/13 on behalf of DLC, Boston Center for Independent Living, Institute for Human Centered Design and the American Association of People with Disabilities. Oral argument is scheduled for winter 2014. The outcome of this case will have a major impact not only on those particular stores throughout Massachusetts and the Country but on all new construction regarding accessibility and entrances to retail stores, buildings, etc. This is a very important issue for all people with disabilities in Massachusetts and throughout the United States.

Welfare Reform This FY DLC and all disability advocates have seen an aggressive attack on state benefits for poor people in general and that includes more than 8,000 parents of children with disabilities. The legislature, as part of their welfare reform efforts, wrote legislation requiring all recipients of cash and food stamp benefits to have their picture on their benefits card to deal with perceived fraud issues. DLC staff advocated very effectively with the state agency responsible for administering these programs and with the legislature to make them aware that people with disabilities may need others to shop for them; ie, family members, personal care attendants, etc. DLC staff testified at hearings, wrote letters informing legislators of the problem and met directly with the Speaker of the House, who understood the issue once explained to him. As a result, all people with disabilities and elders were exempt from this photo ID requirement in the legislation that was passed.

Qualified Allocation Plan (QAP) Advocacy — Low Income Housing Tax Credits for People with Disabilities: The Low Income Housing Tax Credits (LIHTC) program is the federal government’s largest housing production program. It is run not by HUD, but by the IRS, with allocation decisions made by individual states, according to a state plan called a QAP. Since 2008, DLC has worked tirelessly to urge the Department of Housing and Community Development (DHCD) to target resources for the housing of people with disabilities. In this past FY, DLC has finally seen some significant changes as a result of their participation on the DHCD/EOHHS Disability Housing Task Force as well as direct meetings with the DHCD Commissioner and his senior staff. This FY the QAP is being rewritten to include DLC suggestions for not only increase housing resources and options for individuals and families with disabilities but also language regarding the universal design and the "visit ability" of new or renovated housing stock. We are looking forward to our ongoing collaboration with this DHCD regarding these issues.

Nursing Home and Rehabilitation Center Outreach and Monitoring Project Development for FY 13 In the past fiscal year, DLC continued to increase our visibility and advocacy for individuals residing in nursing homes and rehabilitation facilities by collaborating with the Options Counselors in the Independent Living Centers. This work has taken on significant importance since Massachusetts has been granted 3 new Waiver programs to help implement the Money Follows the Person Initiative. DLC will be able to increase their presence in these types of facilities by providing backup and technical assistance as well as representation for individuals who are denied eligibility to these waivers which will ensure discharge with services and supports to the community. The other important development in this area was the settlement of the Hutchinson case which requires that the state provide enhanced outreach to individuals with brain injuries and their families who are currently residing in nursing homes. These folks will be eligible through the brain injury waivers and the MFP waivers. These waivers will provide the supports and services individuals will need to live in the community in either a residential or non-residential habilitation setting.

Health Care Advocacy DLC works on a variety of Cross Disability Health Care Access issues. This includes being an active member of a number of statewide groups focusing on Access to Health Care. This FY DLC staff continued to serve as a member of the Department of Public Health Health and Disability Partnership Advisory Board, working with advocates across Massachusetts to resolve systemic health care issues and working with NDRN on broader issues. However, the most important work we have done this year has focused on the implementation of the One Care Initiative, Massachusetts’s demonstration project, the first in the nation, to change how health care is delivered to those that are Dual eligible for Medicaid and Medicare. There are 110,000 individuals with disabilities who will have the opportunity to participate in a program that promises to deliver healthcare in an integrated, capitated rate system rather than the fee based system that most people are used to. DLC staff have been very involved in all aspects of the development of this program and as part of the Disability Advocates Advancing Health Care Rights (DAAHR) collaboration. DLC has provided legal advice, training and technical assistance on all aspects of this new health care delivery system. DLC will continue to monitor the implementation and will represent anyone denied access to to the services and equipment needs they may have.

Access to Medical Diagnostic and Exam Equipment. DLC is also working in collaboration with Greater Boston Legal Services and the Boston Center for Independent Living on issues related to access to medical equipment. We have a multi-prong approach to this issue which includes regulation changes through the State Access Board, legislation and through direct advocacy with the hospitals and state agencies responsible for ensuring that all people with disabilities have access to the diagnostic and exam equipment necessary to obtain quality health care.

Charlesview Apartments: This is a systemic advocacy case involving wait list procedures and discriminatory impacts on people with disabilities who seek affordable housing and may need reasonable accommodation to have an equal opportunity to apply. As reported last year, DLC conducted testing and filed an administrative complaint with HUD alleging violations of the Fair Housing Amendments Act. HUD found lack of probable cause and to our surprise, upheld that determination upon DLC’s request for reconsideration. DLC continues to believe that this violates existing regulations and we will continue to pursue this issue with the leadership at HUD and DOJ.

Housing for individuals with disabilities. Removing barriers to retain housing for individuals with disabilities remains an important priority for the disability community, the ILC community and DLC. DLC has focused on individual representation on civil rights housing issues that not only have a beneficial impact on the individual with disabilities and their families but hopefully an impact beyond the individual, like that described in the Charlesview Apartment Housing issue discussed above. DLC, in collaboration with the independent living community will continue to leverage our limited resources by providing trainings and legal clinics with advocates that will increase housing law knowledge within the disability community. DLC will continue all efforts to create positive change and promote community inclusion through systemic reform, legislative activities, policy development, training and education.

Trainings The following are examples of some of the trainings that DLC staff conducted that advance the PAIR priorities.

Communication Access in Healthcare Settings DLC training focused on alternative communication technology and individual needs for programmatic access to healthcare for individuals who are deaf and hard of hearing. DLC trained over 30 consumers and staff at a local independent living center on communication access which may include resolving issues such as language barriers, allotting appropriate time for appointments, and ensuring trained and available staff for appointments. DLC staff will offer this training to other independent living center staff and consumers throughout the state.

Making Red Sox Games and Fenway Park Accessible to All

Comprehensive ADA training for more than 500 Red Sox game day staff conducted over a weekend before opening day. Red Sox game day staff includes ushers, ticket takers, security staff and food vendors. Training focuses on interacting with and providing necessary reasonable accommodations for Fenway Park guests who have disabilities. The training also begins with arriving at Fenway, going through security, getting to your seat and accessing all services while at the game. We also discuss accessibility of the Fenway Tours that take place throughout the season. The number of individuals impacted is all individuals with disabilities who visit Fenway throughout the season.

Special Education Trainings and Legal Clinics for Underserved Communities.

DLC was awarded a small grant from the Shapiro Family Foundation which was matched with funding from other grants including the PAIR grant. DLC conducted outreach to a variety of minority communities and as a result, provided six small scale community based special education trainings and one to one legal clinics for all participants. These trainings were delivered in underserved communities in the Greater Boston area. These trainings were conducted in the language of the participants and all materials were translated in that language as well. DLC staff provided trainings and one to one legal clinics at each event for the following communities, African American, Haitian, Vietnamese, Chinese, Creole and Spanish. DLC staff provided a significant amount of legal representation as a follow up to these trainings. We will continue to maintain relationships with these communities

B. Litigation/Class Actions

1. Number of individuals potentially impacted by changes as a result of PAIR litigation/class action efforts0
2. Number of individuals named in class actions0

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

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.

Priority 1: PAIR General Education Priority 1. a statement of each priority; • To reduce the number of students who are out of school due to unilateral action by school districts. • Increase the quality and availability of inclusive programs for students with disabilities, and decrease the number of placements in restrictive settings. • To reduce incidents of abuse, particularly bullying and the use of restraint and seclusion in public and private schools. • To ensure that students 14 years or older receive appropriate transition goals and services in their IEPs. Special consideration will be given to cases where the family has refused a high school diploma.

2. the need addressed by each priority; and; Based on intakes, priority setting meetings and its mandate as a Protection and Advocacy system, DLC has identified these 4 sub-priorities as being of critical importance. Harsh disciplinary practices, lack of appropriate transition services, failure to include students with disabilities in regular education and incidents of abuse and neglect usually result from lack of teacher training and support, as well as lack of knowledge of best practices in educational methodology. Bringing advocacy efforts which focus on the underlying reasons for these problems is best done on both an individual student and systemic level.

3. a description of the activities to be carried out under each priority. Representation: provide aggressive individual advocacy by assisting clients at Team meetings, mediations and hearings before the Bureau of Special Education Appeals.

4. Collaboration: DLC work collaboratively with legal services and private law firms to address systemic issues through legislation, policy and litigation.

5. DLC staff provided representation in 21 cases. None were class actions.

6 Case Summary Paige’ was a 13-year-old 7th grade special education student with Learning Disabilities. She and her family were uprooted and relocated to MA after surviving Hurricane Katrina. Paige had severe disciplinary issues and suffered several suspensions from school. The IEP Team agreed to place her in a substantially separate classroom from May 2013 until the end of school. When school resumed in September, the school returned Paige to an inclusive classroom, but it did not adjust the Placement Consent Form on her IEP to reflect this. The DLC attorney wrote to the school special education director and asked her to correct the IEP. The director made the appropriate correction and sent the document to DLC. The attorney then sent the corrected Placement Consent Form to Paige’s mother. She included instructions on how to complete the Consent Form and send it to the school so Paige’s IEP could now be accurate. . Robert is a 13 year old boy who is legally blind, non-verbal, and uses a wheelchair. He had not made effective academic or non-academic progress for many years. Robert had been bounced around in several in-district school placements and the education team delayed his three year evaluations. Robert’s mother came to the Disability Law Center (DLC) seeking placement in a program that could meet her son’s individual needs. DLC was retained and the first step we took was to find an expert to evaluate the student and to make recommendations regarding services and programming in preparation for filing for a hearing at the Bureau of Special Education Appeals. The expert observed at the student’s most recent placement and attended a team meeting to present her report. In her report, she expressed concerns with his IEP and placement. Specifically, she noted the IEP’s fragmentation, limited focus on academics, lack of assistive technology support, minimal information about functional vision capabilities, and insufficient detail and measurability in many of the annual goals. Thereafter, the parent rejected the IEP in part and rejected the placement. As we were preparing to get ready to file a Hearing Request, the parent informed us that she was moving to another town. The parent is in the in the process of working with her new school district on appropriate programming and a placement that more specifically meets her son’s needs. DLC remains ready to assist Robert and his family obtain the educational services he needs.

Priority 2: PAIR Effective Access and Communication Priority 1. a statement of each priority; Ensure that students who are deaf or hard of hearing or students who are blind or visually impaired are provided with effective access and communication services in their educational settings.

2. the need addressed by each priority; and; Meeting the special education access and communication needs of deaf and hard of hearing students or blind or visually impaired students is complex, whether a student is placed in a public school or a specialized setting. For this reason, many students do not receive appropriate services and are unable to communicate effectively. The decision as to the most appropriate placement should be based on the educational needs of the student. While it is certainly desirable to place hearing impaired and visually impaired students in the local school district setting, qualified teachers with specialized knowledge of instructional methodologies, training and experience, and required certifications may not be available in a school district. In these situations, short or long term placement at a specialized may be needed to provide the most appropriate and essential educational services for the student. Every case must be considered individually to ensure the best possible outcome and placement.

3. a description of the activities to be carried out under each priority. Representation: provide aggressive individual advocacy by assisting clients at Team meetings, mediations and hearings before the Bureau of Special Education Appeals.

4. This priority does not involve collaboration with other entities

5 10 cases and none were class actions

6. “Daniela” is a bright, sunny 3-year-old with a gentle, sparkling smile who loved to draw and color. She is congenitally deaf. Before her second birthday, she had been fitted for a hearing aid and undergone surgery to obtain a cochlear implant. When her mother called the Disability Law Center, Daniela knew only a few signs and could speak only two words. The school district had assigned Daniela to a pre-school that was ill-suited to her needs. The other children could all hear and speak, and the teacher used spoken English with very little American Sign Language. Daniela could not understand what was being taught. She was smart enough to know something was happening that she could not hear, and it made her sad. The speech therapy provided in her Individual Education Program (IEP) offered little more. The therapist also did not sign, and Daniela would spend most of the session in her mother’s lap, learning little. Daniela’s mother asked DLC to find a pre-school placement where Daniela could find her voice, both with sign language and whatever spoken English was possible. DLC retained a well-recognized expert in deaf education and arranged for a Team meeting to discuss Daniela’s needs. When the Team refused to reconsider Daniela’s placement, we filed a Hearing Request the very next day. This prompted the Team to reconsider and recommend a pre-school that uses both spoken and Signed Exact English to teach deaf students. Daniela is thriving at her new pre-school where she is learning both to speak and sign. Daniela’s mother reported that there was a special bonus as a result of DLC’s advocacy for Daniela and her family, when her grandmother, who lives in another country, heard Daniela say hello to her on the telephone for the very first time.

Priority 3: PAIR Appropriate Treatment, Supports & Services Priority 1. a statement of each priority; To increase the number of individuals with disabilities, including children and adolescents, who reside in the community, facilities or residential programs, who receive appropriate treatment, supports and services, in which they fully participate and exercise leadership in decisions about their care, including discharge planning that promotes community integration and ensures timely access to community placement with appropriate supports.

To protect rights related to admission, informed consent, medical treatment, medication and/or appropriate services.

2. the need addressed by each priority; and; To increase the number of individuals with disabilities, including children and adolescents who have adequate discharge planning to community placement with appropriate supports, and to ensure the right of individuals with disabilities to fully participate and exercise leadership in decisions about their care, treatment and discharge planning, including their rights related to admission, informed consent and appropriate medical and psychiatric treatment and services, and to increase the number of Medically Ill/Mentally Ill (MIMI) beds in the community in order to increase the number of psychiatrically stable individuals to be discharged to the community, and to promote community integration.

3. a description of the activities to be carried out under each priority. Provide discharge advocacy for individuals with disabilities, including children and adolescents who currently reside in facilities and residential programs; and to ensure that discharge planning is client directed and that the individual’s right to provide or withhold consent regarding treatment and services is respected.

Monitor the creation and supply of appropriate community placements for all individuals, including those who require specific care and services.

4. This priority involves collaboration with the independent living centers, the nursing home ombudsmen program and other legal services entities.

5. The number of cases handled under this priority was 4 and none were class actions

6. ’Michael’ is a 27-year-old man who lives with a rare, debilitating, neurological illness that has caused him to be now confined to a wheelchair, unable to speak or control many of his muscles, and requiring a feeding tube. Nonetheless, Michael is full of life and he sought DLC’s help when he found himself stuck in a nursing home that was threatening to transfer him to a longer term facility with no plans to discharge him back to his apartment. DLC became involved and the attorney attended various meetings with Michael and his support team (Nursing Home Transition Coordinator and an Options Case Manager). The attorney also attended a meeting with the nursing home social worker and with representatives from the ABI waiver program that Michael applied for. With DLC’s involvement, Michael ended up being accepted to the waiver program that had denied him in the past. After much planning and assessment of his needs, Michael was discharged and is now back in his apartment with appropriate services and supports.

Priority 4: PAIR Facilities Abuse and Neglect Priority 1. a statement of each priority; Reduce the incidence of abuse and neglect of individuals with disabilities in facilities and residential programs.

To reduce or eliminate the use of restraint and seclusion in private and public facilities serving individuals with disabilities. To ensure that use of restraint and seclusion in facilities conforms to state law, federal law and administrative regulations, with an emphasis on those instances which will have the largest impact in reducing the use of restraint and seclusion.

Reduce the incidents of inappropriate treatment by guardians.

2. the need addressed by each priority; and; To ensure access for individuals in facilities and residential programs to adequate and appropriate health, dental and mental health care.

Provide monitoring and analysis of investigation of abuse and neglect allegations, including incidents of restraint and seclusion, conducted by providers, guardians, and state agencies, including hospital emergency departments, and advocate for changes in policies and practices to increase the effectiveness of the investigation of administrative complaints.

Conduct direct, independent investigations into allegations of abuse or neglect, including incidents of restraint and seclusion, of individuals with disabilities. Additionally, assist consumers in appealing inadequate investigations and corrective action plans.

Review selected death investigations, request additional fact-finding as needed and monitor the implementation of required corrective action plans.

3. a description of the activities to be carried out under each priority. To ensure access for individuals in facilities and residential programs to adequate and appropriate health, dental and mental health care.

Provide monitoring and analysis of investigation of abuse and neglect allegations, including incidents of restraint and seclusion, conducted by providers, guardians, and state agencies, including hospital emergency departments, and advocate for changes in policies and practices to increase the effectiveness of the investigation of administrative complaints.

Conduct direct, independent investigations into allegations of abuse or neglect, including incidents of restraint and seclusion, of individuals with disabilities. Additionally, assist consumers in appealing inadequate investigations and corrective action plans.

Review selected death investigations, request additional fact-finding as needed and monitor the implementation of required corrective action plans.

4 This priority involves collaboration with other state agencies responsible for investigating abuse and neglect investigations.

5. DLC handled 3 cases under this priority and none were class actions.

6. Case Summary This case was opened to assess and investigate allegations of Abuse and Neglect from blind consumers attending the Carroll Center’s residential rehabilitation program. We initially received a call from one consumer but others quickly corroborated her claims. The allegations included bullying, sexual harassment, failure to assist a participant who was suicidal, other issues involving physical injury / accidents and a boot camp pedagogical approach which bordered on abuse. To its credit, Massachusetts Commission for the Blind (MCB) took the allegations seriously and the began a number of measures intended to further investigate and respond to these serious allegations. They surveyed all recent clients who went to the Carroll Center for this program. They convened two focus groups of consumers, one of which DLC staff attended in person and the other via speakerphone. They solicited info from complainants and investigated allegations further. Their corrective action plan for the Carroll Center included the following: discussions with high level staff there; plans to form an Advisory Board, requirement of developing guiding principles on staff and consumer obligations, sexual harassment training and safety issues, employee handbook revisions, training for dorm staff on Mental Health issues; voluntary client satisfaction survey for Carroll Center consumers; requirements for critical incident reporting to MCB, and an ombudsperson established through the Advisory Council. We had a reasonably active role in working with both consumers and MCB. DLC was very satisfied that MCB took the allegations seriously and has adopted reasonably effective protocols to prevent future incidents. In light of this, we decided to forgo P&A monitoring and Probable Cause determinations, however, we will be alert to any future allegations of abuse and neglect there.

Priority 5: PAIR Community Inclusion Priority 1. a statement of each priority; Individual Representation on Civil Rights Issues with a focus on Employment (priority for representation given to certain types of cases involving larger employers and current employees seeking reasonable accommodation), Housing (priority given to cases in the United Way Mass Bay and Merrimack Valley service area), Public Accommodations (priority given to cases involving potential to benefit large numbers of people with disabilities), Abuse and Neglect (including independent investigations into allegations of abuse or neglect of individuals with disabilities in the community)

Provision of information/materials to promote self-advocacy with a focus on Employment, Housing (non-United Way service area), Public Accommodations, State/local Government Services, Programs and Activities, Access to Transportation, Deaf Community

Systemic & Impact Advocacy with a focus on Olmstead work (avoiding re-institutionalization), Hospital Access, Entertainment/recreation/health & fitness, Abuse and Neglect prevention and policy advocacy, including monitoring and analysis of investigation of abuse and neglect allegations conducted by provider and state agencies, Training & Education on community inclusion issues, Legislative/Policy work on community inclusion issues, Access to Transportation

2. the need addressed by each priority; and; Although state and federal laws designed to protect people with disabilities from discrimination, such as the Americans with Disabilities Act, the Fair Housing Amendments Act, and M.G.L. c. 151B have been in effect for twenty or more years, individuals with disabilities still face significant difficulties in achieving full inclusion in the economic, communal and social aspects of our society. The Community Team’s Community Inclusion Priority seeks to ensure integration to the fullest extent possible for people with disabilities through enforcement and education regarding anti-discrimination laws, removal of barriers to inclusion, equal access to services, programs and activities and provision of reasonable accommodations, modifications and auxiliary aids and services.

3. a description of the activities to be carried out under each priority. DLC will accept a limited number of cases for individual representation which will primarily be focused on achieving systemic change and/or having a beneficial impact beyond that of the individual client

DLC will leverage its limited resources by expanding knowledge within the disability community on issues of full inclusion and equal opportunity in an effort to empower people with disabilities to advocate for their individual rights.

DLC will seek to create positive change and promote community inclusion through impact litigation, systemic reform, legislative activities, policy development, training and education.

5. DLC handled 28 cases under this priority and none were class actions.

6. Case Summary Employment ‘Lara’ came to the Disability Law Center because she wanted to teach in Massachusetts. The licensing examination was a barrier, however, because Lara is deaf. A portion of the exam required applicants to listen to and transcribe an audio tape. This was difficult for a person who is deaf because it involved several additional steps that a hearing person did not encounter. A sign language interpreter would first have to translate the information on the tape. The applicant would then have to shift her focus to the written page, to transcribe what the interpreter signed. The applicant would then have to look back at the interpreter to see the next series of ASL signs. This back and forth process was exhausting, and there was also no way even to ensure the signing was accurate. DLC represented Lara to ensure that the licensing entity remove the dictation portion, which they agreed to do after DLC explained their legal obligation to accommodate Lara. She is now gainfully employed and licensed as a School Adjustment Counselor.

Public Accommodations and Access to Recreation Jim and his wife tried to enjoy an outdoor concert at a large well known venue in western Massachusetts. Jim, who can only walk short distances and cannot stand for long periods of time, needed to park close to the entrance. The venue sent him to an ’overflow’ parking lot over 1/4 mile away where he and his wife had to wait over forty five minutes in extreme heat for the venue’s jitney. Unfortunately, when the jitney did arrive, there was not enough room for Jim and his wife to board the jitney together. Following this ordeal, Jim contacted DLC to advocate for change. DLC represented Jim and negotiated a change in policies and practices with the venue to improve flow in all of their parking areas. Additionally, the venue has hired a parking and traffic expert and will continue to make improvements in these areas. Jim is excited to return to the venue and have a much better experience as will all other patrons who have mobility impairments and need accessible parking close to the entrance.

Housing Joe is quadriplegic and had a 2 BR Section 8 subsidy administered by Worcester Housing Authority. He had been living in a 2 BR unit with his daughter, who recently joined the military and moved out. He was then downsized to a 1 BR voucher, but remained in his apartment due to the lack of 1 bedroom fully accessible apartments yet he was required to pay the difference in rent, which he could not afford. He requested assistance from DLC with getting his two bedroom voucher back since it was not his fault that he was still in the 2 bedroom unit. After visiting Joe, it became clear that Joe needed the two bedroom unit for the additional space. DLC requested a reasonable accommodation on Joe’s behalf to allow him to keep the 2 BR voucher because he needs the extra space necessary for mobility, strength and exercise equipment. Joe’s need for this equipment and extra space has increased recently because his overall condition and mobility is decreasing with age and he has lost function in his hands. Joe was allowed to remain in his apartment without paying additional rent. Priority 6: PAIR Health/Benefits Systemic Advocacy Priority 1. a statement of each priority; Systemic advocacy to improve access to health care facilities and access to MassHealth covered services. Systemic advocacy may include administrative advocacy, impact work, outreach & training, or technical assistance.

Focus Area A: Systemic advocacy to provide full access to medical care for people with disabilities.

Focus Area B: Systemic advocacy to prevent/ameliorate coverage/service limitations in MassHealth programs for people with disabilities.

2. the need addressed by each priority; and; People with disabilities are denied effective medical care when health care facilities are not fully accessible. This includes physical access, communication access, program access, and equipment access. DPH and the ILCs have requested that DLC work on these issues. This Project began by looking at access to mammography units and then expanded to include all barriers to Hospital Access. DLC completed a training series for providers and is now a member of a number of committees working to further address these issues. Access to MassHealth covered equipment and services is important to the ability of many individuals with disabilities to live and work in the community. Many individuals are denied items and services they need because they do not understand how to use the provider systems, utilization controls, and appeals processes to assert their rights. There are few resources for legal advice or representation on MassHealth denials for equipment and services. Private lawyers do not take these cases because there is no source of payment, and legal services programs have experienced staff reductions. In addition the budget crisis has resulted in increased scrutiny and utilization review of the MassHealth program as a source of savings and increased interest in creating cost saving service delivery systems.

3. a description of the activities to be carried out under each priority. 1. Continue to participate in committee work and collaborate with other advocates. 2. Provide select STA and representation to address these barriers. 3. Provide outreach and training to providers or consumers as needed. 4. Continue to assist individuals with access to MassHealth covered items and services by providing STA, by strategically representing a limited number of individuals who have been denied prior approval for MassHealth covered services necessary to living and working in the community (e.g., DME, PCA, dental, transportation, or pharmacy services), and providing developing consumer materials as needed. 5. Continue to collaborate with and provide short term assistance to other advocates to improve access to MassHealth covered items and services requiring prior approval. 6. Continue to collaborate with and provide short term assistance to other advocates as issues arise that affect access to access to MassHealth delivery systems and access to covered items and services necessary for community living.

4. Pursuing this priority involves collaboration with a number of entities including all legal services programs, the CAP program, Health care advocates and many other disability organizations

5. 3 cases were handled under this priority and none were class actions. However, the most significant amount of work done under this priority includes trainings, participation in a number of coalitions, ongoing dialogue with MassHealth, the Medicaid provider in Massachusetts as well as strategy meetings with other legal service providers.

6 Case Summary PCA Hours

Mary called DLC seeking representation and advocacy to ensure that she retain the number of Personal Care Attendant hours necessary from MassHealth. Mary has vascular necrosis and requires assistance doing pretty much everything related to activities of daily living. Mary was currently receiving 54 hours of PCA services because she falls frequently and breaks bones due to her disability. Mary’s PCA hours were set to expire on November 4, 2012, and she needed assistance in filing a prior authorization form in order to prevent her hours from being cut. At the time Mary called, the Center for Living and Working (CLW) had done the evaluation and they were waiting for Masshealth to get to back to them regarding how many hours they are going to approve. CLW had not submitted the prior authorization and Mary suspected that this would be a barrier to her receiving approval for the hours that she needed. DLC attorneys worked with the ICL advocate to explain the importance of filing a prior authorization with the new evaluation and to ensure that they did submit the prior authorization on time. Mary was allowed the hours she needed as a result of DLC’s intervention. DLC also realized that this was a training issue for all entities that MassHealth contracts with to do the annual evaluation services for PCA hours.

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.

I. Community Inclusion Priority- Focus Areas: • Employment (priority for representation given to certain types of cases involving larger employers and current employees seeking reasonable accommodation) • Housing (priority given to cases where retention of housing & retention of housing subsidy is at stake) • Public Accommodations (priority given to cases involving potential to benefit large numbers of people with disabilities) • Abuse & Neglect (including independent investigations into allegations of abuse or neglect of individuals with disabilities in the community) • State/local Government Services, Programs and Activities • Olmstead work — prevent institutionalization and re-institutionalization, sheltered workshops • Transportation • Post-secondary education • Hospital Access/medical facilities • Entertainment/recreation/health & fitness

II. Education Priority: 1. General Education Priority • Reduce the number of students who are out of school due to unilateral action by school districts. • Increase the quality and availability of inclusive programs for students with disabilities, and decrease the number of placements in restrictive settings. (DLC will continue to advocate for students with developmental disabilities who are Deaf or hard of hearing, or who are blind or who have visual impairments, and need more specialized services or placements.) • Reduce incidents of abuse, particularly bullying and the use of restraint and seclusion in public and private schools. • Ensure that students 14 years or older receive appropriate transition planning from school to work. Ensure goals and services are in all IEPs. Special consideration will be given to cases where the family has refused a high school diploma.

2. Effective Access and Communication Priority • Ensure that students who are deaf or hard of hearing or students who are blind or visually impaired are provided with effective access and communication services in their educational settings.

III. Facilities Priorities 1. Appropriate Supports and Services Priority- • Improve the quality of supports and services (through the sub-areas of informed consent, medical treatment, habilitation, adherence to human rights, self-determination, transition from institutions and community integration)

2. Facilities Abuse and Neglect Priority • Reduce the incidence of abuse and neglect of individuals with disabilities in facilities and residential programs. • To reduce or eliminate the use of restraint and seclusion in private and public facilities serving individuals with disabilities. To ensure that use of restraint and seclusion in facilities conforms to state law, federal law and administrative regulations, with an emphasis on those instances which will have the largest impact in reducing the use of restraint and seclusion. • Reduce the incidents of inappropriate treatment by guardians.

IV. Health/Benefits Systemic Advocacy Priority Systemic advocacy to improve access to health care facilities and access to MassHealth covered services. Systemic advocacy may include administrative advocacy, impact work, outreach and training, or technical assistance.

Focus Areas: • Systemic advocacy to provide full access to medical care for people with disabilities. • Systemic advocacy to prevent/ameliorate coverage/service limitations in MassHealth programs for people with disabilities.

Part VI. Narrative

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

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

  1. Sources of funds received and expended
  2. Budget for the fiscal year covered by this report
  3. Description of PAIR staff (duties and person-years)
  4. Involvement with advisory boards (if any)
  5. Grievances filed under the grievance procedure
  6. Coordination with the Client Assistance Program (CAP) and the State long-term care program, if these programs are not part of the P&A agency

a. October 2012 through September 2013 Income 3060 • US DOE 288,503.95 Total Income 288,503.95

b. Expense 5010 • Gross Payroll 164,687.61 5190 • Fringe Allocation 77,269.36 5220 • Data Processing 401.69 5230 • Audit / Accounting 1,683.54 5260 • Interpreters 1,305.42 5290 • Professional Services 5,983.71 5310 • Staff Travel 1,124.08 5320 • Conferences - Local 224.63 5330 • Conferences / Travel 738.53 5340 • Dues / Memberships 769.97 5350 • Publications 791.08 5360 • On Line Services 1,585.32 5370 • Malpractice Insurance 947.82 5410 • Supplies - Boston 1,364.90 5415 • Supplies - W Mass 52.50 5420 • Postage- Boston 232.40 5425 • Postage - W Mass 32.64 5440 • Reproduction 811.70 5610 • Equipment Rental - Boston 433.30 5615 • Equipment Rental - WM 254.29 5630 • Equipment R/M - Boston 237.76 5635 • Equipment R/M - WMass 40.64 5710 • Boston Office 18,019.41 5720 • W. Mass Office 5,883.23 5740 • Property Insurance 232.94 5750 • Telephone-Boston 1,215.68 5760 • W. Mass Telephone 767.28 5810 • Meetings Expense 174.47 5830 • Litigation Expense 1,150.00 5840 • Bank Interesr/Serv Charge 88.05 Total Expense 288,503.95 Net Income 0.00

c. Attorney 25,144.55 29% Attorney 15,071.21 29% Attorney 5,375.14 6% Attorney 3,302.60 5% Attorney 12,792.22 17% Attorney 3,234.69 4% Attorney 12,043.18 17% Attorney 4,933.68 8% Attorney 7,383.10 16% Director of Administration 5,801.33 11% Director of Finance/IT 12,941.44 11% Executive Director 9,299.96 11% Litigation Director 26,680.52 23% Paralegal 6,202.97 11% Paralegal 6,225.27 11% Support Staff 4,562.97 11% Support Staff 3,692.78 11% Total 164,687.61 2.33

d. DLC Staff are involved with the following boards and task force groups Board of Boston Center for Independent Living Boston Housing Authority Transfer Working Group Center Club of Boston CHAPA Committee on Access for People with Disabilities Coalition for the Legal Rights of People with Disabilities Coalition to Defend Special Education DDS Human Rights Advisory Committee Department of Developmental Services Investigation Advisory Committee Department of Mental Health Human Rights Task Force Disability Abuse Prevention Task Force Disability Advocates Advancing Health Care Rights Disability Housing and Economic Development & Executive Office of Health and Human Services Disability Housing Task Force DMH Human Rights Advisory Committee Education Law Task Force Employment Rights Coalition Human Rights Advisory Committee Long Term Care Ombudsman Program Directors Advisory Council MA 21 Coalition Massachusetts Disability Determination Services Advisory Committee Massachusetts Rehabilitation Commission MassMatch Advisory Committee Massachusetts Systems Transformation Grant Housing Subcommittee Paid Sick Days Coalition Personal Care Attendant Coalition Social Action Committee of the Health Task Force of the Boston Bar Association Special Education Collaborative Group State DMH Planning Committee

e. No grievances were filed under PAIR for the reporting period.

f. DLC collaborates with the CAP program on a regular basis because we refer cases to each other on a daily basis. DLC and MOD (the CAP program in Massachusetts) have combined staff meetings where we discuss cases and issues that we are both seeing. We recently met (all DLC staff and all CAP staff) to discuss exactly what cases we will refer to them and vice versa. We are dedicated to ensuring that we are not duplicating efforts. We are also working on a number of initiatives together such as access to health care issues, state licensing issues that are related to obtaining reasonable accommodations in testing necessary to obtain a license and a variety of physical access issues in state institutions such as prisons, elementary and higher education buildings and state psychiatric facilities. DLC also works closely with Massachusetts Ombudsman program that is housed within the Office of Elder Affairs. DLC is an active member of the Western MA Nursing Home Ombudsman Directors bi-monthly meetings, in partnership with Community Legal Aid (formerly Western MA Legal Services). These meetings serve as a forum to provide legal assistance to the Ombudsman Directors and to coordinate efforts with Community Legal Aid. This ensures that both organization offer different, and complimentary, legal services and eliminates redundancy. The meetings have also led to several individual client referrals from the Ombudsman Directors and have alerted DLC to systemic issues to focus on in the coming year.

Other Coordination: DLC works closely with the Massachusetts Department of Public Health, who in addition to licensing long term care facilities which includes rest homes also promulgate regulations regarding the rights of clients and the responsibility of facilities. DPH also has the authority to investigate facilities and to order remedial action when necessary. We are currently working with DPH to ensure that rest homes are providing accessible and quality care to the populations that are served in 84 rest homes throughout the state. DLC also works very closely with attorneys at Greater Boston Legal Services who represent seniors living in nursing homes and similar types of facilities under specialized funding they receive to do that work. GBLS also has the Medicare Advocacy Project (MAP) and our healthcare attorneys work closely with the MAP attorneys.

Certification

Signed?Yes
Signed ByChristine M Griffin
TitleExecutive Director
Signed Date01/05/2014