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

Michigan (MICHIGAN PROTECTION AND ADVOCACY SERVICES, INC. -- CLIENT ASSISTANCE PROGRAM) - H240A140023 - FY2014

General Information

Designated Agency Identification

NameMichigan Protection and Advocacy Service Inc.
Address4095 Legacy Parkway
Address Line 2Suite 500
CityLansing
StateMichigan
Zip Code48911
E-mail Addressecerano@mpas.org
Website Addresshttp://www.mpas.org
Phone517-487-1755
TTY 517-487-1755
Toll-free Phone800-288-5923
Toll-free TTY800-288-5923
Fax517-487-0827
Name of P&A Executive DirectorElmer L. Cerano
Name of PAIR Director/CoordinatorMark A. Cody
Person to contact regarding reportMark A. Cody
Contact Person phone517-487-1755
Ext.628

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 areas251
2. Individuals receiving I&R outside PAIR priority areas1,622
3. Total individuals receiving I&R (lines A1 + A2)1,873

B. Training Activities

1. Number of trainings presented by PAIR staff39
2. Number of individuals who attended training (approximate)1,115

Access to Justice Seminar, Wayne State University, Detroit Training 13

Bluff’s Edge Awareness Rights Training & Workshop, U.P. Training 20

How to Better Understand Your Mental Health and Educational Rights, Bad Axe Training 12

How to Better Understand Your Mental Health and Educational Rights, Gladwin Training 8

How to Better Understand Your Mental Health and Educational Rights, Marquette Training 10

How to Better Understand Your Mental Health and Educational Rights, Menominee Training 11

How to Better Understand Your Mental Health and Educational Rights, Peck Training 9

Special Education Rights Training, Dia de la Muier, East Lansing Training 55

Special Education Rights Training - MDHS Wraparound Coordinators, Marquette Training 11

Special Education Rights Training - Michigan Family Voices, Flint Training 12

Special Education Rights Training - Michigan Family Voices, Hastings Training 10

Special Education Rights Training, Michigan Family Voices, Muskegon Training 20

Special Education Rights Training - University of Michigan Law School, Ann Arbor Training 13

Special Education Rights Training, DHS Wraparound Coordinators, Lansing Training 46

Special Education Rights Training, DHS Wraparound Staff, Lansing Training 27

Special Education Rights Training, Lincoln Behavioral Services, Southgate Training 25

Special Education Rights Training, MACLU/NAACP, Lansing Training 45

Special Education Rights Training, MAF, ARC Statewide Conference Training 17

Special Education Rights Training, MAF, Early On Webinar 21

Special Education Rights Training, MAF, Lansing Training 10

Special Education Rights Training, MAF, Saginaw Training 18

Special Education Rights Training, MAF Staff, Lansing Webinar 65

Special Education Rights Training, MAF Staff, Lansing Webinar 18

Special Education Rights Training, MAF Webinar 28

Special Education Rights Training, MAF, Detroit Training 57

Special Education Rights Training, MAF, Grosse Pointe Training 11

Special Education Rights Training, MAF, Port Huron Training 49

Special Education Rights Training, MAF, Port Huron Training 37

Special Education Rights Training, MSU School of Social Work, Saginaw Training 20

Special Education Rights Training, NDRN Annual Conference, Maryland Training 106

Special Education Rights Training, Oakland County Youth Assistance Training 75

Special Education Rights Training, Special Populations Conference Training 40

Special Education Rights Training, Student Advocacy Center, Ann Arbor Training 10

Special Education Rights Training, U of M Law School, School Discipline Clinic Training 20

Special Education Rights Training, U of M Student Representation Project Training 50

Special Education Rights Training, University of Michigan Law School Seminar Training 11

Special Education Rights Training, Urban League, Battle Creek Training 3

Special Education Rights Training, WSU Law School, STPP Symposium, Detroit Training 90

Special Education Training Rights Presentation - St. Joseph ISD Parent Advisory Committee Training 12

NOTE: Not all of these trainings/webinars were funded 100% by PAIR. They were collaborative activities with other MPAS funding areas and staff.

C. Information Disseminated to the Public

1. Radio and TV appearances by PAIR staff1
2. Newspaper/magazine/journal articles20
3. PSAs/videos aired0
4. Hits on the PAIR/P&A website24,033
5. Publications/booklets/brochures disseminated426
6. Other (specify separately)0

Narrative

MPAS maintains a Facebook page. The number of “friends” of MPAS has steadily increased since the page was launched and we now have 1,076 Likes/Friends. This has proven to be an effective means of communicating with many individuals.

PAIR funding also supports the activities of the Great Lakes ADA Steering Committee. GLADA distributes mini-grants that promote accessibility in the community.

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)44
2. Additional individuals served during the year68
3. Total individuals served (lines A1 + A2)112
4. Individuals w. more than 1 case opened/closed during the FY. (Do not add this number to total on line A3 above.)2

B. Individuals served as of September 30

Carryover to next FY may not exceed total on line II. A.3 above 42

C. Problem Areas/Complaints of Individuals Served

1. Architectural accessibility1
2. Employment3
3. Program access3
4. Housing2
5. Government benefits/services7
6. Transportation1
7. Education2
8. Assistive technology3
9. Voting0
10. Health care21
11. Insurance0
12. Non-government services0
13. Privacy rights0
14. Access to records0
15. Abuse15
16. Neglect56
17. Other0

D. Reasons for Closing Individual Case Files

1. Issues resolved partially or completely in individual favor50
2. Other representation found1
3. Individual withdrew complaint0
4. Appeals unsuccessful3
5. PAIR Services not needed due to individual's death, relocation etc.0
6. PAIR withdrew from case2
7. PAIR unable to take case because of lack of resources0
8. Individual case lacks legal merit9
9. Other7

Please explain

Closed and reopened to different funding source.

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 assistance3
3. Investigation/monitoring39
4. Negotiation1
5. Mediation/alternative dispute resolution1
6. Administrative hearings8
7. Litigation (including class actions)20
8. Systemic/policy activities0

Part III. Statistical Information on Individuals Served

A. Age of Individuals Served as of October 1

Multiple responses not permitted.

1. 0 - 40
2. 5 - 221
3. 23 - 5928
4. 60 - 648
5. 65 and over75

B. Gender of Individuals Served

Multiple responses not permitted.

1. Females59
2. Males53

C. Race/Ethnicity of Individuals Served

For individuals who are non-Hispanic/Latino only

1. Hispanic/Latino of any race2
2. American Indian or Alaskan Native1
3. Asian1
4. Black or African American41
5. Native Hawaiian or Other Pacific Islander0
6. White62
7. Two or more races0
8. Race/ethnicity unknown5

D. Living Arrangements of Individuals Served

Multiple responses not permitted.

1. Independent19
2. Parental or other family home2
3. Community residential home4
4. Foster care1
5. Nursing home77
6. Public institutional living arrangement2
7. Private institutional living arrangement1
8. Jail/prison/detention center5
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 impairment9
2. Deaf/hard of hearing5
3. Deaf-blind1
4. Orthopedic impairment26
5. Mental illness3
6. Substance abuse0
7. Mental retardation3
8. Learning disability1
9. Neurological impairment30
10. Respiratory impairment7
11. Heart/other circulatory impairment17
12. Muscular/skeletal impairment3
13. Speech impairment0
14. AIDS/HIV3
15. Traumatic brain injury2
16. Other disability2

Part IV. Systemic Activities and Litigation

A. Systemic Activities

1. Number of policies/practices changed as a result of non-litigation systemic activities3

2. Number of individuals potentially impacted by policy changes15,000

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.

Statewide Nursing Home Project:

As a result of MPAS advocacy, legal authorities are aware of abuse occurring in nursing care facilities and are investigating incidents. MPAS reviewed 444 nursing home survey reports and filed individual complaints against the professional licenses of doctors, nurses, and other health care providers. In fiscal year 2014, these complaints produced the following outcomes:

•2 licensed practical nurses (LPNs) each received 6 months probation. •5 LPNs and 5 registered nurses (RNs) each received a 1 year probation. •1 RN received 2 years probation. •1 LPN received a formal reprimand. •2 medical doctors (MDs) received sanctions. •9 LPNs/RNs were ordered to complete continuing education courses at their own expense. •1 MD voluntarily completed a continuing education course. •A total of $10,750 in fines were issued to the LPNs/RNs/MDs above.

Home- and Community-Based Medicaid Services:

MPAS staff conducted a review of the new federal regulations governing home- and community-based services funded by Medicaid. The staff review concluded that, at a minimum, 4,701 Michiganders with disabilities are living in licensed adult foster care (AFC) homes that do not meet the standards of the new rules. Research into other characteristics of the new rules will add thousands of additional residents living in AFCs, which are currently out of compliance. The report concluded that, "given the scope of the affected residents and providers, the State of Michigan and the disability advocacy community must immediately begin to collaborate and plan for the upcoming transition to the new rules." MPAS staff incorporated this report into written public comments on Michigan’s plan to address the requirements in the new rules.

Michigan Juvenile Collaborative Activities:

MPAS met with various advocacy organizations to improve coordination and communication between agencies, with the goal of becoming more effective in advocating for youth in juvenile justice facilities.

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.

A. Priority: Eliminate Abuse/Neglect

1. Describe the priority.

Prevent consumers from being subjected to restraint and/or seclusion or otherwise abused and/or neglected.

2. Identify the need, issue, or barrier addressed by this priority.

People with disabilities too often are subjected to abuse and/or neglect. This can occur in facilities or in the community. In addition, the use of restraint and/or seclusion is an ongoing problem, particularly in schools and some types of facilities that are virtually unregulated. Abuse/neglect is especially prevalent in nursing facilities.

3. Identify and describe indicators PAIR used to determine successful outcome of activities pursued under this priority.

If abuse and/or neglect is confirmed, whether appropriate corrective measures are taken to prevent future incidents.

4. Explain whether pursuing this priority involved collaborative efforts by other entities. If so, describe this collaboration.

MPAS works collaboratively with the Office of Recipient Rights of the Michigan Department of Community Health, the State Long Term Care Ombudsman, as well as licensing and certification agencies.

5. Provide the number of cases handled under this priority. Indicate how many of these, if any, were class actions.

Forty-one cases, no class actions.

6. Provide at least one case summary that demonstrates the impact of the priority. MPAS investigated an allegation of client not receiving any treatment for diabetes while at a nursing home, resulting in death. The Legal Team became involved to address access to records. A complaint allegation was submitted to Health Professions against the medical doctor’s license.

The doctor was reprimanded and received a $5,000 fine.

A. Priority: Improve Rights Protection Systems

1. Describe the priority.

Advocate for effective systems and proceedings to safeguard the rights of consumers.

2. Identify the need, issue, or barrier addressed by this priority. People with disabilities frequently have their civil rights compromised by ineffective rights protection systems and overreaching guardians. 3. Identify and describe indicators PAIR used to determine successful outcome of activities pursued under this priority.

Whether the client received effective assistance from rights protection systems and/or whether the client was protected from a loss of personal rights as a result of a guardianship.

4. Explain whether pursuing this priority involved collaborative efforts by other entities. If so, describe this collaboration.

No collaboration.

5. Provide the number of cases handled under this priority. Indicate how many of these, if any, were class actions.

One case, no class actions.

6. Provide at least one case summary that demonstrates the impact of the priority.

MPAS assisted a client who was being discharged from a nursing facility to understand her legal rights in the process. As a result, the client was able to advocate for herself.

A. Priority: Eliminate Employment Barriers and Protect Rights

1. Describe the priority.

To ensure that consumers have access to competitive employment and their rights under state and federal law are protected.

2. Identify the need, issue, or barrier addressed by this priority.

Nationwide, the data indicate that persons with disabilities continue to be underemployed and unemployed compared to persons without an identified disability. Although legal protections exist to address this issue, individuals with disabilities are most likely to receive assistance and representation from the private bar when they have been discharged from employment. For these individuals, legal assistance that is most effective focuses on negotiating reasonable accommodations with an employer prior to discharge. Unfortunately, many individuals with significant disabilities are unable to secure legal representation for any employment related issue. Finally, many individuals with disabilities are employed in settings that allow for deviated wages based on level of productivity and, as a result, they are not compensated as fully as is required by law for individuals in other settings.

3. Identify and describe indicators PAIR used to determine successful outcome of activities pursued under this priority.

Whether the client was able to secure or maintain competitive employment.

4. Explain whether pursuing this priority involved collaborative efforts by other entities. If so, describe this collaboration.

MPAS and the Lt. Governor held a news conference to announce the publication of the Employment First Report. This report makes the case for reform of education, community mental health, rehabilitation services, and other service providers to ensure that individuals with disabilities are employed in competitive work settings and receive competitive wages.

5. Provide the number of cases handled under this priority. Indicate how many of these, if any, were class actions.

One case, no class actions.

6. Provide at least one case summary that demonstrates the impact of the priority.

Our client is visually impaired. Her employer, a county agency, required that she use software that was not able to accommodate her needs. MPAS advised and assisted the consumer in filing complaints with federal agencies.

A. Priority: Improve Access to Necessary Services

1. Describe the priority.

Advocacy for services to maintain consumers in the community and for obtaining accommodations in critical services.

2. Identify the need, issue, or barrier addressed by this priority.

Particularly in a time of severe funding shortages, the availability of services and supports for consumers is being compromised. In addition, many providers of critical services, such as hospitals, units of local government, etc. are not making needed physical and/or programmatic accommodations.

3. Identify and describe indicators PAIR used to determine successful outcome of activities pursued under this priority.

Whether the client was able to gain or maintain needed services.

4. Explain whether pursuing this priority involved collaborative efforts by other entities. If so, describe this collaboration.

MPAS worked with the State Long Term Care Ombudsman on cases involving termination of services provided through the Home and Community Based Services Nursing Facility Waiver.

5. Provide the number of cases handled under this priority. Indicate how many of these, if any, were class actions.

Twenty-four cases, no class actions.

6. Provide at least one case summary that demonstrates the impact of the priority.

Our client, a gentleman in his 90s resided in the community. Because of his impairments, he relied upon the MiChoice program, Michigan’s HCBS Nursing Facility Waiver, to provide him with services and supports to remain in the community. However, the waiver agent notified our client and 16 other individuals, that supports would be drastically reduced. Had this occurred, the client would have been forced to move into a nursing facility.

MPAS successfully represented these individuals in administrative hearings. As a result of MPAS representation, this client and all the other consumers, were able to stay in the community, in the home of their choosing.

A. Priority: Ensure the Right to a High Quality Education

1. Describe the priority.

Advocacy to ensure that students with disabilities will receive the highest and best education possible and they will be fully prepared for entry into the competitive workforce.

2. Identify the need, issue, or barrier addressed by this priority.

Students with disabilities are too often placed in segregated learning environments, are suspended, or expelled for disability related conduct, or are not adequately prepared for work.

3. Identify and describe indicators PAIR used to determine successful outcome of activities pursued under this priority.

Whether the client was able to gain or retain access to general education or is prepared to enter the workforce.

4. Explain whether pursuing this priority involved collaborative efforts by other entities. If so, describe this collaboration.

MPAS has worked extensively with the Michigan Alliance for Families to provide training for parents of children with disabilities and to identify systemic issues.

5. Provide the number of cases handled under this priority. Indicate how many of these, if any, were class actions.

Two cases, no class actions.

6. Provide at least one case summary that demonstrates the impact of the priority.

A client was discharged from a vocational school after he disclosed that he is HIV positive. MPAS assisted the client with filing a complaint with the United States Department of Justice. His complaint is still pending with DOJ but it has focused attention on the practices of this school.

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.

B. Priority: Eliminate Abuse/Neglect

1. Describe the priority.

Prevent consumers from being subjected to restraint and/or seclusion or otherwise abused and/or neglected.

2. Identify the need, issue, or barrier addressed by this priority.

People with disabilities too often are subjected to abuse and/or neglect. This can occur in facilities or in the community. In addition, the use of restraint and/or seclusion is an ongoing problem, particularly in schools and some types of facilities where regulations are ineffective in curtailing these practices.

3. Description of the activities to be carried out.

Educate policymakers, in an effort to establish better measures to protect consumers and to eliminate the use of restraint and/or seclusion; investigations into suspected abuse/neglect cases and follow-up as needed; and appropriate litigation.

B. Priority: Improve Rights Protection Systems

1. Describe the priority.

Advocate for effective systems and proceedings to safeguard the rights of consumers.

2. Identify the need, issue, or barrier addressed by this priority.

People with disabilities frequently have their civil rights compromised by ineffective rights protection systems and/or overreaching guardians.

3. Description of the activities to be carried out.

Advocacy in individual cases of abuse/neglect, financial exploitation, or forced treatment by guardians, and education of policy makers.

B. Priority: Eliminate Employment Barriers and Protect Rights

1. Describe the priority.

To ensure that consumers have access to competitive employment and their rights under state and federal law are protected.

2. Identify the need, issue, or barrier addressed by this priority.

Nationwide, the data indicate that persons with disabilities continue to be underemployed and unemployed compared to persons without an identified disability. Although legal protections exist to address this issue, individuals with disabilities are most likely to receive assistance and representation from the private bar when they have been discharged from employment. For these individuals, legal assistance that is most effective focuses on negotiating reasonable accommodations with an employer prior to discharge from employment. Furthermore, many individuals with significant disabilities are unable to secure legal representation for any employment related issue. Finally, many individuals with disabilities are employed in settings that allow for deviated wages based on level of productivity and, as a result, they are not compensated as fully as is required by law for individuals in other settings.

3. Description of the activities to be carried out.

Representation in individual or systemic litigation, and as needed, assistance to consumers in asserting their rights.

B. Priority: Improve Access to Necessary Services

1. Describe the priority.

Advocate for services to maintain consumers in the community and for accommodations needed to access critical services and discharge planning including access to services in facilities (e.g., nursing homes).

2. Identify the need, issue, or barrier addressed by this priority.

Particularly in a time of severe funding shortages, the availability of services and supports for consumers is being compromised. In addition, many providers of critical services, such as hospitals, units of local government, etc. are not making needed physical and/or programmatic accommodations.

3. Description of the activities to be carried out.

Representation in individual and systemic cases involving denial or termination of critical services needed to avoid institutionalization or to secure discharge to the community.

B. Priority: Ensure the Right to a High Quality Education

1. Describe the priority.

Advocate to ensure that students with disability related behavior will remain in school and that students will receive appropriate transition services to be fully prepared for entry into the competitive workforce.

2. Identify the need, issue, or barrier addressed by this priority.

Students with disabilities are too often placed in segregated learning environments, are suspended, or expelled for disability related conduct, or are not adequately prepared for work.

3. Description of the activities to be carried out.

Advocacy in systemic and individual cases and policy advocacy.

Part VI. Narrative

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

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

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

A. Sources of funds received and expended:

U.S. Department of Education (FY 2012-2013)

U.S. Department of Education (FY 2013-2014) $461,081

MPAS Unrestricted Funds $ 24,525

Total Available for FY 2014 $485,606

Total expended for FY 2013 $463,533

Note: PAIR funding was fully expended towards the end of FY 14, casework was continued using agency unrestricted funds.

B. Budget

2014 Actual 2015 Projected

Admin $ 45,606 $ 43,000

Services $427,436 $416,000

Other $ 12,564 $ 11,000

Total $486,606 $470,000

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

1. Duties

PAIR supports both advocates and attorneys who provide information and referral, direct advocacy and legal representation to PAIR eligible clients. The advocates who provide information and referral services discuss a variety of legal issues related to the disability of the client. Advocates and attorneys providing direct advocacy and legal representation do so in these areas: (1) Community integration and community supports; (2) Abuse and Neglect; (3) Discharge Planning; (4) Rights Protection; (5) Employment; and (6) Education.

2. Person Years

PAIR had 6.1 FTEs of direct advocacy staff during FY 2014. PAIR pays a federally approved indirect cost rate of 10.2%, which funds administration, finance, human resources, and information systems.

PAIR funded staff have focused on the condition and treatment of individuals in nursing facilities. Multiple complaints were filed with state licensing agencies. PAIR funded staff have also worked with the State Long Term Care Ombudsman to challenge terminations of services and supports for individuals residing in the community. This is a concern due to changes in the funding mechanisms for these services. The state of Michigan now funds the nursing facility waiver services using a managed care model. This has resulted in some waiver agents proposing drastic reductions in services. Had MPAS not successfully intervened, many individuals would have been forced into nursing facilities.

D. Involvement with advisory boards (if any)

MPAS staff was actively involved with the Statewide Independent Living Council, the Michigan Disability Housing Workgroup, the Michigan Disability Network, the Transition and Education Advisory groups of the Michigan Department of Career Development, the Community Housing Network, and the Juvenile Justice Waiver Workgroup.

E. Grievances filed under the grievance procedure

MPAS received one grievance from PAIR eligible consumers.

F. Coordination with the Client Assistance Program (CAP) and the State long-term care program, if these programs are not part of the P&A agency.

The CAP is part of MPAS. MPAS works in cooperation with the State Long Term Care Ombudsman.

Certification

Signed?Yes
Signed ByElmer L Cerano
TitleAuthorized Certifying Official
Signed Date12/10/2014