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

Iowa (IOWA P and A SERVICES, INC.) - H240A150016 - FY2015

General Information

Designated Agency Identification

NameDisability Rights Iowa
Address400 East Court Avenue
Address Line 2Suite 300
CityDes Moines
StateIowa
Zip Code50309
E-mail Addressinfo@driowa.org
Website Addresshttp://www.driowa.org
Phone515-278-2502
TTY 515-278-0571
Toll-free Phone800-779-2502
Toll-free TTY866-483-3342
Fax515-278-0539
Name of P&A Executive DirectorJane Hudson, Executive Director
Name of PAIR Director/CoordinatorCynthia A. Miller
Person to contact regarding reportCynthia A. Miller
Contact Person phone515-278-2502
Ext.32

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 areas3
2. Individuals receiving I&R outside PAIR priority areas170
3. Total individuals receiving I&R (lines A1 + A2)173

B. Training Activities

1. Number of trainings presented by PAIR staff28
2. Number of individuals who attended training (approximate)1,014

The following were 15 trainings conducted by staff that related to the PAIR program in FY15: Alternatives to Guardianship: DRI provided 5 trainings on alternatives to guardianship/conservatorship. 1. Iowa State Bar Association annual conference: DRI co-presented at this conference with Iowa Dept. on Aging to educate attorneys and judges on alternatives to guardianship and specific issues in rights restrictions in Iowa guardianships and conservatorships. 2. Office of Substitute Decision Maker training event: DRI presented on Olmstead and alternatives to guardianship to an audience of attorneys, Area Agency on Aging staff, administrators and providers. 3. County Case Managers: DRI presented to a group of county case managers for people with ID on alternatives to guardianship and specific issues in substitute decision making. 4. Childserve: DRI did a training for case managers and supervisors at Childserve, a SNF/NF and community provider for children with significant disabilities, on guardianship and the rights of an individual. 5. Candeo: DRI trained the leadership team and a guardian at Candeo, a provider of community based services to adults with ID, MI, and TBI, on alternatives to guardianship and individual rights. Education and transition planning: DRI provided 4 trainings in the area of special education or transition. 1. Waukee high school: DRI did a training/outreach event to parents of high school children with disabilities on transition and services provided by DRI, as well as Q&A on various topics including benefits planning. 2. Wrights Law: DRI participated in ASK Resource hosted online Wrights Law follow up Q&A for attorneys along with the Iowa Dept. of Education. 3. PTI conference: DRI presented to parents and students on disciplinary regulations under IDEA and worked through scenarios with discipline flowchart. 4. PTI conference: DRI presented on parent and student rights in IEPs to parents and students. Employment Rights: DRI conducted 4 trainings on employment rights in FY15. 1. Spina Bifida conference: DRI presented at the Spina Bifida conference entitled “Knowing your rights under the Americans with Disabilities Act” and did an overview of titles I-III of the ADA. 2. PTI Conference: DRI presented on why the transition process for students with disabilities to integrated employment is important and how to use employment accommodations. 3. CHSC and FNN: DRI trained RNs and staff of Child Health Specialty Clinics and the Family Navigator Network on transition to work and reasonable accommodations. 4. Iowa Transition Conference: DRI presented on why the transition process for students with disabilities to integrated employment is important and how to use employment accommodations. Accessibility: DRI conducted 2 trainings on accessibility in FY15. 1. UI School of Social Work: DRI trained social work students at the University of Iowa on the ADA, barriers to employment, and accessibility issues. 2. Americorps: DRI presented to an Americorps class on ADA Title II and III issues.

C. Information Disseminated to the Public

1. Radio and TV appearances by PAIR staff2
2. Newspaper/magazine/journal articles3
3. PSAs/videos aired0
4. Hits on the PAIR/P&A website18,787
5. Publications/booklets/brochures disseminated1,178
6. Other (specify separately)0

Narrative

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)16
2. Additional individuals served during the year57
3. Total individuals served (lines A1 + A2)73
4. Individuals w. more than 1 case opened/closed during the FY. (Do not add this number to total on line A3 above.)1

B. Individuals served as of September 30

Carryover to next FY may not exceed total on line II. A.3 above 16

C. Problem Areas/Complaints of Individuals Served

1. Architectural accessibility5
2. Employment23
3. Program access9
4. Housing3
5. Government benefits/services1
6. Transportation6
7. Education4
8. Assistive technology1
9. Voting0
10. Health care3
11. Insurance0
12. Non-government services0
13. Privacy rights0
14. Access to records0
15. Abuse2
16. Neglect0
17. Other17

D. Reasons for Closing Individual Case Files

1. Issues resolved partially or completely in individual favor32
2. Other representation found1
3. Individual withdrew complaint9
4. Appeals unsuccessful0
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 merit11
9. Other4

Please explain

Three files were closed due to no contact with individual. One file was not resolved in the individual's favor, but DRI's intervention gave her the time necessary to take steps to protect herself from additional financial exploitation.

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-advocacy10
2. Short-term assistance31
3. Investigation/monitoring0
4. Negotiation11
5. Mediation/alternative dispute resolution0
6. Administrative hearings0
7. Litigation (including class actions)5
8. Systemic/policy activities1

Part III. Statistical Information on Individuals Served

A. Age of Individuals Served as of October 1

Multiple responses not permitted.

1. 0 - 40
2. 5 - 226
3. 23 - 5953
4. 60 - 645
5. 65 and over9

B. Gender of Individuals Served

Multiple responses not permitted.

1. Females30
2. Males43

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. Asian0
4. Black or African American5
5. Native Hawaiian or Other Pacific Islander0
6. White63
7. Two or more races2
8. Race/ethnicity unknown0

D. Living Arrangements of Individuals Served

Multiple responses not permitted.

1. Independent57
2. Parental or other family home6
3. Community residential home1
4. Foster care0
5. Nursing home5
6. Public institutional living arrangement0
7. Private institutional living arrangement0
8. Jail/prison/detention center4
9. Homeless0
10. Other living arrangements0
11. Living arrangements not known0

E. Primary Disability of Individuals Served

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

1. Blind/visual impairment7
2. Deaf/hard of hearing4
3. Deaf-blind0
4. Orthopedic impairment14
5. Mental illness5
6. Substance abuse0
7. Mental retardation5
8. Learning disability0
9. Neurological impairment13
10. Respiratory impairment3
11. Heart/other circulatory impairment4
12. Muscular/skeletal impairment3
13. Speech impairment1
14. AIDS/HIV0
15. Traumatic brain injury1
16. Other disability13

Part IV. Systemic Activities and Litigation

A. Systemic Activities

1. Number of policies/practices changed as a result of non-litigation systemic activities5

2. Number of individuals potentially impacted by policy changes45,250

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.

Health Consumer Ombudsman Alliance: As a result of legislation passed by the Iowa General Assembly, DRI partnered with multiple other agencies to develop a plan for providing a permanent coordinated system of independent consumer supports to ensure that consumers, including those covered under Medicaid managed care obtain and maintain essential health care; are provided with unbiased information in understanding coverage models; and are assisted in resolving problems regarding health care services, coverage, access and rights. Issues addressed include how to provide advocacy for complaints, grievances and appeals to the individuals receiving long-term services and supports under 7 HCBS waivers or individuals in institutional care (change to Medicaid managed care system). This is an ongoing project in anticipation of the transition to managed care, and a proposed budget will be submitted to the governor and general assembly by December 15, 2015. Guardianship and Conservatorship Task Force: On January 14, 2015 the Iowa Supreme Court ordered the establishment of a Guardianship and Conservatorship Reform Task Force to review Iowa’s laws and procedures to ensure the system is efficient and responsive to the needs of Iowans. DRI submitted written comments to provide input regarding current issues we see in the existing system that affect individuals with disabilities including how the courts need better oversight of annual reports and the systemic failure to consider less restrictive alternatives before ordering a plenary guardianship or conservatorship. DRI also provided oral testimony before the Steering Committee highlighting some of our written comments including the need to review alternatives to guardianships/conservatorships to maximize self-determination and the inappropriate use of voluntary guardianships that abuse the rights of individuals with disabilities. DRI was also appointed to one of the five workgroups and over the next year will review changes need in the establishment of Adult Guardianships and Conservatorships including the statutory criteria for guardianship and conservatorship, capacity assessments of proposed wards, appointment of public guardians or conservators, the role of the attorney and guardian ad litem for proposed wards and the use of limited and voluntary guardianships and conservatorships. Access in Emergency Management: DRI participated in the state's emergency planning and preparedness activities to ensure Iowans with disabilities are integrated into the State's emergency planning and have equal access to emergency programs and services. Worked to ensure emergency programs, services and activities would be provided at locations people with disabilities can access, and that Iowans with disabilities will be given information that is comparable in content and detail to that given to the general population. Village NW and Sheldon School District (Policy/practice change): DRI collaborated with a sheltered workshop, Workshop Village Northwest in Sheldon, along with the school district and AEA to discuss strategies to move towards inclusive employment services. DRI provided materials related to the Workforce Innovation and Opportunity Act, transition planning, and has served as a technical assistance provider as requested. As a result of DRI’s work students with significant needs will have IEPs with transition goals focusing on community work instead of sheltered work. This will be accomplished by utilizing Vocational Rehabilitation and the AEA challenging behavior team. Sexual Expression in Long Term Care: The taskforce includes Iowa Department of Aging, Long Term Care Ombudsman, Iowa Department of Inspections and Appeals and Disability Rights Iowa. We have worked on creating a Sexuality Police Guidebook where we provide a framework for facilities to develop their own policies on sexual expression. We are also working on developing a FAQ factsheet or booklet with all the collaborative agencies logos/contact information that will provide education and information for both facilities and individuals living in facilities to know their legal rights. LTCO has already developed a factsheet for distribution by our agencies on Debunking the myths in Sexuality and Aging and another on capacity vs. competency to create an understanding that the terms are different and understanding that difference is essential to determinate whether an individual’s consent is valid. DIA is following up with CMS on what guidance they have for facilities and how to expand their guidance to include sexual expression rights. All agencies are reviewing where we can do collaborative training such as staff provider, aging or disability conferences in FY16. Substitute Decision Making Task Force (Policy change): DRI was a participant on the Substitute Decision Making Task Force since 2013. The Task Force made recommendations that the Iowa Legislature fund the Office of Substitute Decision Making which it did and in 2015, the Office was up and running with an attorney and paralegal providing education, information and representation to individuals on guardianship and conservatorship. The reestablishment of OSDM will greatly benefit individuals with disabilities in need of substitute decision making services, advice on less restrictive alternatives to guardianship/conservatorship, and assistance modifying or terminating unnecessarily restrictive or abusive substitute decision makers. Special education advisory panel: DRI continues to sit on the IDEA mandated statewide advisory panel that provides advice/recommendations to the DOE. DRI staff participates in the meetings held six times per year and advocates in internal subcommittees at the meetings concerning special education services. Iowa Commission of Persons with Disabilities: This seven-member commission appointed by the Governor meets at least quarterly to discuss issues concerning employment opportunities and barriers, and accessibility of programs, services and facilities for people with disabilities. Commission members this year attended a Youth Leadership Forum in Ames, Iowa, contacted shopping malls throughout the state of Iowa to advise of the impact people with disabilities have when they are able to have equal access to businesses and shopping, and hosted a legislative meeting at the State Capitol to update legislatures on current disability concerns and issues involving their constituents. State fair project (policy change): This is an ongoing systemic project were DRI continues to work with the Iowa State Fair administration (ISF) to have the fairgrounds reviewed and to come to a negotiated settlement with the ISF for ADA compliance. As reported last year, ISF administration hired Disability Action Consultants (DAC) to complete a self-evaluation and transition plan to address accessibility issues. In FY15, DAC completed their review of the fairgrounds and issued a lengthy report to the ISF. DRI submitted organizational comments to the ISF in response to their request for stakeholder input and assisted in gathering individual survey responses to give input on current and future needs. DRI noted that the ISF began making changes to their website to better reflect ADA compliant disability assistance and communications needs. ISF also created a new policy on the disability assistance with campground access. DRI will likely close the file in FY16 once the multi-year transition plan is completed and distributed. AEA/ASK Child Find: The AEA, PTI and DRI collaborated to develop a presentation on Child Find that is now on all collaborators websites to educate parents, LEAs and AEAs on the process of child find. The presentation is now on all collaborators websites with scripts for training. Non-emergency medical transportation (policy change): DRI continues to sit on the NEMT Member Advisory Council to make recommendations for improvements to Iowa Medicaid Enterprise and the state’s broker for NEMT, TMS. The MAC meets quarterly. DRI reviewed the RFP for the reissuing of the broker’s contract and offered comments. The RFP was withdrawn when the state announced a transition to managed care, but DRI has continued to monitor how this will impact Medicaid recipients and how the MCOs will provide NEMT under their respective contracts. Finally, DRI was involved in notifying the state of concerns with interruptions in service and a disparate impact on people with disabilities due to the broker implementing a policy requiring eligible members in need of a ride to use their local Paratransit service. As a result of the MAC members’ advocacy, the broker and Medicaid made the policy optional rather than mandatory. County Jails Project: To continue efforts in DRI’s Systemic Jail Project, DRI monitored 20 County Jails in addition to the 10 County Jails monitored in the previous fiscal year. During these monitoring trips DRI staff interviewed Jail Administrators responsible for each facility about the housing, treatment, and correctional considerations concerning inmates with disabilities and mental illness in county jail facilities. DRI also met with individual inmates when possible, and always if there was a resident who contacted DRI, to interview them and inform them of DRI services. Regional Directors of each of Iowa’s Mental Health and Disability Services organizations were interviewed about existing or planned jail diversion services. DRI continued to collaborate with, and attend regular meetings of the Iowa Therapeutic Alternatives to Incarceration organization, a jail diversion advocacy group, and also attended a statewide jail diversion training symposium. Additionally DRI participated in a regional conference focusing on behavioral health system and supports, and law enforcement response. As a result of the monitoring trips, interviews, national and local research, DRI produced a cumulative report detailing the state of incarceration of disabled and mentally ill inmates in county jails in the state, and is planning to release that report strategically in the next fiscal year, along with personalized recommendations to every jail visited. As part of DRI’s efforts in this area we also served individuals who requested services. Physical Accessibility in Des Moines University (policy change): DRI contacted the president of Des Moines University regarding the lack of accessible seating in a meeting/conference room that is available for public rental and has been used to host outside organizations and events in the past. The building was designed and built after the adoption of the 1991 Standards for Accessible Design, but failed to adhere to architectural and accessible seating requirements for assembly areas. As a result of DRI’s advocacy, the university president met with the building’s architects and promised to make structural alterations in order to bring the room into compliance with the ADA. Future events hosted at this venue will have accessible seating and people with physical disabilities, particularly those who use wheelchairs will benefit from this change.

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.

While DRI did not file any class actions in 2015, we have engaged in litigation on an individual’s behalf when necessary. A few examples are: Employment: DRI filed an administrative complaint with the Iowa Civil Rights Commission (ICRC) on behalf of an individual with a diagnosis of blepharospasm and meige condition whose employment was terminated after exhaustion of his FMLA leave and the employer’s failure to respond to his request for accommodations and return him to work. Upon the issuance of a right to sue letter by ICRC, DRI partnered with co-counsel from a private law firm and filed an employment discrimination complaint in state court. Defendant employer removed the case to federal court in the Southern District of Iowa. Following the hearing on Motion for Summary Judgment filed by the employer, the parties mediated and agreed to settle the case. Parties settled the case in October (FY16) for monetary damages including attorney fees paid to DRI. We will report this on the FY16 PPR in greater detail. Accessibility: DRI filed an action in federal district court in September 2015 against a local restaurant on behalf of an individual with a disability who uses a mobility device due to the location being inaccessible. The parties negotiated for nearly a year prior to filing with no action taken by the restaurant despite assurances they would correct the accessibility issues. The lawsuit is pending but parties are currently negotiating a settlement including installation of a ramp to the front entrance, installation of electronic door openers on the front entrance doors, and a review of the route of travel and accessibility of the bathroom. DRI will report on the outcome of this case in the FY16 PPR.

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.

PAIR PPR 2015 Part V A. Priorities and Objectives for the Fiscal Year covered by this report Abuse and Neglect: 1. Priority: Individuals with disabilities shall be free from abuse and neglect. 2. Need addressed: Individuals with disabilities may be subject to abuse, neglect, or financial exploitation. This is often due to the dependency that individuals with disabilities develop requiring assistance with food, personal cares, and personal safety. Individuals with disabilities may not understand how to report instances of abuse or neglect and may be concerned about retaliation if they complain. Staff may not be adequately trained to handle behavioral challenges. 3. Description of Activities: DRI will collaborate with the Iowa Department of Inspections and Appeals, the Iowa Department of Corrections, the Iowa Long-Term Care Ombudsman and the Citizens Aide Ombudsmen to investigate any deaths, abuse, neglect or systemic rights violations of individuals with disabilities or mental illness. DRI will also provide technical assistance to individuals who call asking for assistance about how to handle individual rights violations. Priority will be given to investigations in facilities. 4. Collaboration: See Description of facility closure collaboration with Long Term Care Ombudsman and Iowa Department of Inspections and Appeals in Section VI. DRI also reviews incident reports from DIA or the Department of Corrections for any patterns of abuse and neglect and will conduct follow up monitoring or investigations as necessary. DRI completed 22 secondary investigations in response to notices from these two agencies. 5. Number of cases: 2. Number of class actions: 0 6. Case Summary: Client is an 85 year old woman with a diagnosis of depression, diabetes, kidney disease, and Alzheimer’s living in assisted living. Her granddaughter was previously appointed her conservator and guardian for ten years. The client is wealthy but was not provided with income to do the things she would like to do, go out to dinner occasionally and get her hair permed. The client was also concerned that the conservator is making decisions based on future inheritance. After the conservatorship was terminated, the granddaughter continued to try to gain access to the client’s finances. An elder abuse petition was filed to protect the client from financial exploitation. A temporary protective order was provided based on the prima facie showing of elder abuse on the petition. During the time of this temporary protective order, the client was able to protect her assets in a trust. The order was eventually lifted due to the court’s final decision that elder abuse was not found. Accessibility: 1. Priority: Individuals with disabilities have the right to full participation of programs, services and activities of public entities and public accommodations. 2. Need addressed: Individuals with disabilities may be excluded from participation in public services and public accommodations because of a failure to make facilities accessible or to provide reasonable accommodations. 3. Description of Activities: a. DRI will investigate and provide legally-based advocacy concerning physical or architectural accessibility issues involving public entities. b. DRI will provide legally-based advocacy for qualified individuals with disabilities who are excluded from participation in or denied the benefits of the services, programs or activities of public entities because of their disability, including but not limited to the failure to allow service animals as required by law, and the failure of public entities to provide reasonable accommodations in the process of applying for services. c. DRI will provide legally-based advocacy to individuals who are discriminated against on the basis of disability in the full and equal enjoyment of goods, services, facilities, privileges, advantages, or accommodations of any place of public accommodation by any person who owns, leases (or leases to) or operates a place of public accommodation. d. DRI will provide systemic legally based advocacy to ensure Iowans with disabilities will be integrated into the State’s emergency planning, ensuring that their accessibility and functional needs are addressed and that they have equal access to emergency programs and services. e. DRI will provide legally-based advocacy to individuals who experience disability-based discrimination in housing. 4. Collaboration: See section IV for systemic collaboration descriptions on Access in Emergency Management, State Fair project, County Jails project. 5. Number of cases: 22 Number of class actions: 0 6. Case Summary: Client is an 81 year old woman with lung cancer, rheumatoid arthritis. Client lives in an apartment with her husband. Client's doctor recommended she move to a higher level of care due to her disabilities, and client's son and daughter in law arranged to let client and her husband live with them. Client's landlord is demanding $2000 early termination fee to release client from lease. Client cannot afford to pay, seeking legal guidance. DRI drafted letter to property mgmt company requesting early termination and waiver of fees as reasonable accommodation for disability under the Fair Housing Act. DRI negotiated with property manager's attorney, who ultimately agreed to waive fee, and release client and her husband from the lease in exchange for surrender of their deposit. Client approved of this compromise. Client is a 39 year old male diagnosed with blindness, traumatic brain injury, and mental illness. He contacted DRI to request assistance in obtaining audio books and assistance writing letters as accommodations while he is incarcerated in Anamosa State Penitentiary. DRI contacted the prison, and the service provider of the audio books and arranged to have clients audio-book privileges reinstated. DRI worked with prison staff to ascertain available resources and ensure access to necessary accommodations. As a result of DRI advocacy, the client now has regular access to a library selection of audio books at no charge to him. The client has also been provided with personal assistance reading and writing, so that he can communicate via mail effectively. Community Integration: 1. Priority: Iowans with disabilities have the right to live in the most integrated and least restrictive settings appropriate to their choice and needs. 2. Need addressed: Individuals with disabilities should be able to live as independently as possible and in the setting they desire. Barriers appear when the living situations are more restrictive than what is necessary to address safety or medical concerns, or considerations are not given to the use of reasonable accommodations, aids or services that could enable individuals with disabilities to reside where they choose. 3. Description of Activities: a. DRI will provide individual and systemic legally based advocacy to individuals with disabilities or mental illness and are inappropriately placed in overly-restrictive nursing facilities or community settings. b. DRI will provide systemic and individual legally-based advocacy to ensure that individuals with disabilities are being served in the most integrated settings possible and have the community services to which they are entitled under federal and state law. DRI will not provide case-management services and will not represent individuals to remain in institutional placements. c. DRI will provide individual and systemic advocacy to individuals who are not receiving transportation services to which they are legally entitled. d. DRI will conduct systemic advocacy to ensure that Iowa Medicaid Enterprise/DHS develop and implement a transition plan to become fully complaint with CMS HCBS Settings Final Rules. 4. Collaboration: See Section IV for systemic collaboration description for Non-Emergency Medical Transportation Member Advisory Council with Iowa Medicaid Enterprise and the state NEMT broker. DRI also collaborates with Long Term Care Ombudsman to review cases of individuals seeking to move from facilities to community integrated settings. 5. Number of cases: 7. Number of class actions: 0 6. Case Summary: Client is a 54 year old woman with spine issues, diabetes, and uses a wheelchair for mobility. Client has been denied requests for transportation from Medicaid broker due to a car registered at her home, but she requires accessible transportation to get to her appointments. She wanted assistance obtaining NEMT. DRI contacted the Medicaid broker on client’s behalf and clarified her need for accessible transportation. Client was granted a six month exception to policy to allow her to access transportation. Education: 1. Priority: Students with disabilities have the right to enforce and protect their rights for special education and related services under the Individuals with Disabilities Education Act (IDEA) and Rehabilitation Act Section 504. 2. Need addressed: Students with disabilities are at risk of not being educated, being restrained or secluded, or subjected to the use of law enforcement for disciplinary purposes. 3. Description of Activities: a. DRI will provide legally-based advocacy for students who are repeatedly suspended, expelled, constructively expelled, restrained or secluded, arrested or forced to have a shortened school day for behavior related to their disability. b. DRI will provide systemic advocacy for students who do not have transition plans that comply with the IDEA. This will include systemic advocacy to improve transition planning in facilities that serve court-involved juveniles with disabilities or mental illness. c. DRI will partner with other organizations to increase the number and quality of attorneys representing families and students in special education cases. 4. Collaboration: See collaborative projects in Section IV. DRI has continued to collaborate with the Parent Training Information Center (PTIC)/ASK Resource Center by having regular meetings to review cases and present education topics to each other’s staff. This allows for effective referrals appropriate to each agency’s goals and priorities. DRI continues to have a strong working relationship with our state’s Department of Education and has worked on education issues in juvenile justice facilities. 5. Number of cases: 4 Number of class actions: 0 6. Case summary: This 14 year old male with ADHD and ODD in addition to history of trauma has been repeatedly suspended from school for behavior related to his disability. DRI participated in an IEP meeting to determine what additional supports might be needed and reduce the use of suspension. As a result, the student was not suspended for the remainder of the year. Employment: 1. Priority: DRI will provide legally-based advocacy for the disability rights of Iowans who are experiencing disability-based discrimination in employment. 2. Need addressed: Individuals with disabilities may be excluded from the workplace due to fear and inflexibility with accommodation requests, and are likely to be terminated from employment because of the disability. 3. Description of Activities: a. DRI will provide legally-based advocacy for individuals who encountered disability discrimination in gaining, maintaining or regaining employment, including failure to provide reasonable accommodations. b. DRI will collaborate with other organizations to provide training to employers and individuals with disabilities about the benefits of employing individuals with disabilities and the employment protections for individuals with disabilities under state and federal law. 4. Collaboration: See Employment trainings in section IB. 5. Number of cases: 17 Number of class actions: 0 6. Case summary: Client is a 45 year old man with epilepsy. Client has gone over 20 years without a seizure, but recently experienced one while at his job as a machine setup attendant in a manufacturing plant. Client was placed on leave/disability pending medical clearance. His doctor cleared him, but his employer would not allow him to return, citing safety concerns and demanding additional specific info from the doctor, which she could not provide, or had already provided. Client wanted assistance returning to work and/or arranging any necessary accommodations. DRI obtained and reviewed relevant medical records and correspondence from employer, researched client’s job description and spoke with client about what accommodations he would need to perform his job. DRI drafted a letter to plant manager requesting a meeting with client to arrange for accommodations and return client to work. Plant manager and HR met with client and his wife, discussed accommodations and agreed to return client to work with slight modifications to his job in order to reduce the risk of injury. Client is a 49 year old woman with lymphedema, orthopedic disabilities, mobility impairment. Client has worked from home in her position as a hospital credentialer/transcriptionist for four years. Recently her employer informed her she would be expected to begin working five half days per week on location. Client requested continued accommodation to work from home but was denied. She wanted DRI assistance arranging accommodations, and to continue working from home if possible. DRI negotiated with employer’s attorney and HR personnel and advised client of possible options consistent with ADA, FMLA rights. DRI arranged for client to work in house as requested, with significant accommodations in place. Client returned to work. Supportive Decision-Making & Alternatives to Guardianship 1. Priority: DRI will provide advocacy for the disability rights of Iowans to pursue alternatives to guardianships or conservatorships, to end guardianships or conservatorships when no longer necessary, to change guardians or conservators in cases of abuse or neglect, and hold other legal decision makers accountable for violating the rights of the person with a disability. 2. Need addressed: Individuals with disabilities may be subjected to unnecessary guardianships and conservatorships and have the right to have an appropriate guardianship that is as narrowly tailored as possible. 3. Description of Activities: a. DRI will provide trainings to judges, providers, and individuals with disabilities and their family members on less restrictive alternatives to guardianships and conservatorships. b. DRI will provide legally-based advocacy to prevent or terminate guardianships and conservatorships for those who are no longer in need of a guardian or a conservator. c. DRI will provide legally based advocacy for individuals whose representative payees fail to act in their best interests as required by the Social Security Administration. 4. Collaboration: See trainings in Part IB, and collaborative systemic projects in Part IV. 5. Number of cases: 5 Number of class actions: 0 6. Case summary: Case summary (to include client demographics and issues/problems: Client is a 26 year old male with mild intellectual disability. He lives in a group home setting. His parents had him sign a voluntary petition for guardianship when he was 18. It was intended to be for medical purposes only but has since become very restrictive. The guardians have engaged in unsolicited conversations with the client's pregnant girlfriend questioning the paternity of her child when the client was at work, the guardians have prevented the client from leaving the RCF except for work or medical appointments, the guardians have without legal authority began to control the client's earned income, the guardians dictate every social activity of the client and make every decision for him. Client used to work in integrated employment however the guardians have decided he will only work in sheltered work and do not want him to ever return to integrated employment. Client wanted to have the guardianship terminated. Discussed situation with client. DRI represented client in termination of guardianship proceedings. An injunction was filed after the Guardians attempted to unnecessarily move the client to higher level of care against the client's wishes. The court issued an order prohibiting any move during proceedings and ordered the guardians to stop engaging the client in conversations intended to pressure the client into dropping his case. The parties ultimately agreed to substitute a professional guardian and the current guardian is assisting client with finding a living situation in the community with third party supports. Client began transitioning into integrated employment and is now in charge of his own earned income.

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.

PAIR PPR 2015 Part V B. Priorities and Objectives for the Current Fiscal Year Abuse and Neglect: 1. Priority: Individuals with disabilities shall be free from abuse and neglect. 2. Need addressed: Individuals with disabilities may be subject to abuse, neglect, or financial exploitation. This is often due to the dependency that individuals with disabilities develop requiring assistance with food, personal cares, and personal safety. Individuals with disabilities may not understand how to report instances of abuse or neglect. 3. Description of Activities: DRI will collaborate with the Iowa Department of Inspection and Appeals (DIA), the Iowa Department of Corrections (DOC), the Iowa Long-Term Care Ombudsman and the Citizens Aide Ombudsman to investigate any deaths, abuse, neglect or systemic rights violations of individuals with disabilities or mental illness. DRI will also provide technical assistance to individuals who call asking for assistance about how to handle individual rights violations. Priority will be given to investigations in facilities. DRI will monitor nursing facilities and skilled nursing facilities where people with ID, MI, or other disabilities reside. DRI will participate as part of a team to review placement and transfer of individuals with disabilities when a facility closes. Accessibility: 1. Priority: Individuals with disabilities have the right to full participation of programs, services and activities of public entities and public accommodations. 2. Need addressed: Individuals with disabilities may be excluded from participation in public services and public accommodations because of a failure to make facilities accessible or to provide reasonable accommodations. 3. Description of activities: a. DRI will provide legally-based advocacy for qualified individuals with disabilities who are excluded from participation in or denied the benefits of the services, programs or activities of public entities because of their disability, including, but not limited to, physical or architectural barriers, the failure to allow service animals as required by law and the failure of public entities to provide reasonable accommodations in the process of applying for services. b. DRI will provide legally-based advocacy to individuals who are discriminated against on the basis of disability in the full and equal enjoyment of goods, services, facilities, privileges, advantages, or accommodations of any place of public accommodation by any person who owns, leases (or leases to), or operates a place of public accommodation. c. DRI will provide legally-based advocacy to individuals who experience disability-based discrimination in housing. Community Integration: 1. Priority: Iowans with disabilities have the right to live in the most integrated and least restrictive settings appropriate to their choice and needs. 2. Need addressed: Individuals with disabilities should be able to live as independently as possible and in the setting they desire. Barriers appear when the living situations are more restrictive than what is necessary to address safety or medical concerns, or considerations are not given to the use of reasonable accommodations, aids or services that could enable individuals with disabilities to reside where they choose. 3. Description of activities: a. DRI will provide individual and systemic legally-based advocacy to individuals who have a disability or mental illness and are inappropriately placed in overly-restrictive nursing facilities or community settings. b. DRI will provide systemic and individual legally-based advocacy to ensure that individuals with disabilities or mental illness are being served in the most integrated settings appropriate to their needs and preferences. DRI will not provide case-management services. DRI will not represent individuals who want to remain in institutional placements. c. DRI will provide individual and systemic advocacy to individuals who are not receiving transportation services to which they are legally entitled. d. DRI will conduct systemic advocacy to insure that Iowa Medicaid Enterprise/DHS/managed care organizations develop and implement a transition plan to become fully compliant with CMS HCBS Settings Final Rules. e. DRI will provide individual and systemic advocacy to individuals with disabilities or mental illness in resolving problems regarding health care services, coverage, access and rights as Iowa transitions Medicaid services to Managed Care. Education: 1. Priority: Students with disabilities have the right to enforce and protect their rights for special education and related services under the Individuals with Disabilities Education Act (IDEA) and Rehabilitation Act Section 504. 2. Need addressed: Students with disabilities are at risk of not being educated, being restrained or secluded, or subjected to the use of law enforcement for disciplinary purposes. 3. Description of activities: a. DRI will provide legally-based advocacy for students who are repeatedly suspended, expelled, constructively expelled, restrained or secluded, arrested or forced to have a shortened school day for behavior related to their disability. b. DRI will partner with other organizations to increase the number and quality of lawyers representing families and students in special education cases. Employment: 1. Priority: DRI will provide legally-based advocacy for the disability rights of Iowans who are experiencing disability-based discrimination in employment. 2. Need addressed: Individuals with disabilities may be excluded from the workplace due to fear and inflexibility with accommodation requests, and are likely to be terminated from employment because of the disability. 3. Description of activities: a. DRI will provide legally-based advocacy for individuals who encountered disability discrimination in gaining, maintaining or regaining employment, including failure to provide reasonable accommodations. b. DRI will collaborate with other organizations to provide training to employers and individuals with disabilities about the benefits of employing individuals with disabilities and the employment protections for individuals with disabilities under state and federal law. Supportive Decision-Making & Alternatives to Guardianship 1. Priority: DRI will provide advocacy for the disability rights of Iowans to pursue alternatives to guardianships or conservatorships, to end guardianships or conservatorships when no longer necessary, to change guardians or conservators in cases of abuse or neglect, and hold other legal decision makers accountable for violating the rights of the person with a disability. 2. Need addressed: Individuals with disabilities may be subjected to unnecessary guardianships and conservatorships and have the right to have an appropriate guardianship that is as narrowly tailored as possible. 3. Description of activities: a. DRI will provide trainings to judges, providers and individuals with disabilities and their family members on less restrictive alternatives to guardianships and conservatorships. b. DRI will provide legally- based advocacy to prevent or terminate guardianships/conservatorships for those who are no longer in need of a guardian/conservator.

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 Received: 230,190 Expended: 198,939 B. Budget for the fiscal year covered by this report: FY15 FY16 Projected Salaries 130,495.01 117,278.00 Fringe Benefits 28,610.28 21,741.00 Materials/Supplies 3,519.01 4,679.00 Postage 391.77 288.00 Telephone 1,052.04 674.00 Rent 15,788.62 13,646.00 Travel 3,255.02 1,432.00 Copying 999.90 892.00 Insurance 3,540.62 3,315.00 Legal Services 522.48 125.00 Miscellaneous 6,415.11 3,960.00 Professional Services 4,348.87 6,494.00 Total 198,938.72 174,524.00 C. Description of PAIR staff (duties and person-years) Attorneys 56% Advocates 23% Paralegal 9% Mgmt/Finance 12% D. Involvement with advisory boards (if any) DRI sits on the following boards or workgroups: NEMT Member Advisory Council Iowa Commission of Persons with Disabilities Sexual Expression in Long Term Care Task Force Special Education Advisory Panel Substitute Decision Making Task Force Guardianship and Conservatorship Task Force Iowa Developmental Disabilities Council Iowa Disability Action Network Money Follows the Person work group Olmstead Task Force Mental Health Conference Planning Committee Community Partnership Advisory Council of the Center for Disabilities and Development at the Univ. of Iowa E. Grievances filed under the grievance procedure DRI had two (2) grievances filed in 2015 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 In Iowa, the CAP and LTCOP are not part of the P&A system. DRI strengthened its network with the Iowa CAP Coordinator, Page Eastin, through collaboration and referrals. Page has referred several clients with legal issues to DRI and shared insights into common issues she sees when individuals wish to appeal a vocational rehabilitation decision. DRI and CAP have also worked together as part of a workgroup examining a statewide expansion of benefits planning in Iowa. DRI continues to have a good relationship and collaboration with the LTCOP in a number of areas. DRI and LTCOP completed work on creating and implementing a Long-Term Care Facility Closure/Crisis Manual in collaboration with Iowa Department of Inspections and Appeals, Iowa Department of Human Services, and Iowa Medicaid Enterprise. DRI and LTCOP also participated in the meetings and planning for five different facility closures representing 230 residents. DRI and LTCOP continued joint work on a Sexuality Police Guidebook to provide a framework for facilities to develop their own policies on sexual expression. We are also working on developing a FAQ factsheet or booklet with all the collaborative agencies logos/contact information that will provide education and information for both facilities and individuals living in facilities to know their legal rights. This project will continue in FY16 with a focus on finding opportunities to collaboratively train the target audience. DRI and LTCOP are both part of the Health Consumer Ombudsman Alliance which is tasked with submitting a budget and proposal for how it can serve and protect the rights of Medicaid recipients during and after the transition to managed care. A DRI attorney and an attorney from the LTCOP did a joint training for Iowa attorneys on less restrictive alternatives to guardianship and conservatorship, and the legal rights of individuals in need of substitute decision making. DRI and LTCOP routinely refer cases to one another and collaborate to assist individuals in facilities to uphold their rights and find community integrated services if they so desire.

Certification

Signed?Yes
Signed ByCynthia A. Miller
TitleLegal Director
Signed Date12/22/2015