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

Kentucky (KENTUCKY OFFICE FOR PUBLIC ADVOCACY - P and A DIVISION) - H240A160018 - FY2016

General Information

Designated Agency Identification

NameKentucky Protection and Advocacy
Address5 Millcreek Park
Address Line 2
CityFrankfort
StateKentucky
Zip Code40601
E-mail Addresssusan.abbott@ky.gov
Website Addresshttp://www.kypa.net
Phone502-564-2967
TTY 800-372-2988
Toll-free Phone800-372-2988
Toll-free TTY800-372-2988
Fax502-564-0848
Name of P&A Executive DirectorJeff Edwards
Name of PAIR Director/CoordinatorSusan Abbott
Person to contact regarding reportSusan Abbott
Contact Person phone502-564-2967
Ext.0

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 areas22
2. Individuals receiving I&R outside PAIR priority areas305
3. Total individuals receiving I&R (lines A1 + A2)327

B. Training Activities

1. Number of trainings presented by PAIR staff68
2. Number of individuals who attended training (approximate)920

Kentucky P&A staff visited 68 nursing facilities and provided information to administrators and staff about services available to assist in the transition of residents of nursing facilities to the community. This included information about the Home and Community Based Waiver, the Supports for Community Living Waiver, specialized services offered by the local Community Mental Health Centers, and Pre-Admission Screening and Resident Review (PASRR). Information about long term care rights was also provided to the residents. Kentucky P&A staff provided information and training at a Bully Prevention Workshop in Franklin County, to parents groups at Ahrens Vocational School in Louisville, to parents at a special education camp in Elizabethtown and at the Anderson County Schools Parent Resource Forum, to the Scott County Highshcool Transition Fair. Training included information about student rights, Individualized Education Plans, alternatives to guardianship and special education and transitioning to adult life. Training was also provided to the volunteer long term care ombudsmen group in Louisville, staff at Our Lady of Peace Hospital, at the Disability Community Resource Fair in Lexington, Project Safe Summit, “New Tools for Promoting Safety for People with Disabilities Who Have Experienced Sexual and Domestic Violence”, the annual ARC of Kentucky Conference, Brain Injury Alliance of Kentucky (BIAK) , the Victim Assistance Conference in Lexington, and to Hear it Here in Louisville. Kentucky P&A participated in two non-disability related events, providing information about Kentucky P&A. One was the Frankfort Relay for Life event and the other was at the Latino, Immigrant and Refugee Summit hosted by the Kentucky Commission on Human Rights.

C. Information Disseminated to the Public

1. Radio and TV appearances by PAIR staff0
2. Newspaper/magazine/journal articles3
3. PSAs/videos aired0
4. Hits on the PAIR/P&A website234,320
5. Publications/booklets/brochures disseminated895
6. Other (specify separately)0

Narrative

Kentucky P&A also held two public forums in 2016 where the public was invited to make comment about the work and priorities of Kentucky P&A. Notices were placed in local newspapers, on Kentucky P&A’s website, Facebook page and Twitter account. The first was held at the World Fest, in Louisville, Kentucky where over 200 individuals met with P&A staff. and the second public forum was held in Morehead, Kentucky. Areas of concern most identified by participants are abuse/neglect, outreach to minorities and underserved population, education, community supports, healthcare and employment. Kentucky P&A staff takes public comment forms to trainings and to outreach events. The top five areas of concern for individuals with disabilities are health care, abuse/neglect, guardianship and restoration of rights, community supports and outreach to minorities. Kentucky P&A continues to maintain a Facebook Page and posts regional and national information about employment, fair wage, and retaining benefits and discrimination. Kentucky P&A has a Twitter account, https://twitter.com/kyadvocacy . In addition to these efforts, Kentucky P&A regularly updates its website and provides information about employment, benefits, fair wage and transition at www.ky.pa.net Since November 2012, P&A has had a disability rights advocate at the DPA office located in Prestonsburg, KY. This initiative is to increase the visibility of P&A and also increase the number of individuals served by P&A in the eastern part of the state, an underserved geographic population. Through this new presence, we have increased our direct client representation, educated service providers on rights related issues, and provided training/resources to persons with disabilities. Since relocating, the disability rights advocate has contacted numerous facilities and programs in this 24 county region to discuss how best to deliver information about P&A and rights related information to the people with disabilities and those who support them. Over 70 regional facilities/programs have received letters about this new P&A outreach effort and seven disability rights related information presentations have been given to over 100 people with disabilities and/or disability related support staff. The counties included in this outreach effort are as follows: Boyd, Breathitt, Carter, Clay, Elliott, Floyd, Greenup, Harlan, Johnson, Knott, Lawrence, Lee, Leslie, Letcher, Lewis, Magof?n, Martin, Menifee, Morgan, Owsley, Perry, Pike, Rowan, and Wolfe.

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)29
2. Additional individuals served during the year34
3. Total individuals served (lines A1 + A2)63
4. Individuals w. more than 1 case opened/closed during the FY. (Do not add this number to total on line A3 above.)63

B. Individuals served as of September 30

Carryover to next FY may not exceed total on line II. A.3 above 33

C. Problem Areas/Complaints of Individuals Served

1. Architectural accessibility0
2. Employment1
3. Program access2
4. Housing1
5. Government benefits/services2
6. Transportation0
7. Education9
8. Assistive technology2
9. Voting0
10. Health care16
11. Insurance0
12. Non-government services1
13. Privacy rights1
14. Access to records0
15. Abuse9
16. Neglect23
17. Other0

D. Reasons for Closing Individual Case Files

1. Issues resolved partially or completely in individual favor21
2. Other representation found0
3. Individual withdrew complaint2
4. Appeals unsuccessful0
5. PAIR Services not needed due to individual's death, relocation etc.8
6. PAIR withdrew from case1
7. PAIR unable to take case because of lack of resources0
8. Individual case lacks legal merit2
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-advocacy6
2. Short-term assistance5
3. Investigation/monitoring15
4. Negotiation2
5. Mediation/alternative dispute resolution0
6. Administrative hearings3
7. Litigation (including class actions)3
8. Systemic/policy activities0

Part III. Statistical Information on Individuals Served

A. Age of Individuals Served as of October 1

Multiple responses not permitted.

1. 0 - 41
2. 5 - 2212
3. 23 - 5922
4. 60 - 648
5. 65 and over20

B. Gender of Individuals Served

Multiple responses not permitted.

1. Females33
2. Males30

C. Race/Ethnicity of Individuals Served

For individuals who are non-Hispanic/Latino only

1. Hispanic/Latino of any race0
2. American Indian or Alaskan Native0
3. Asian0
4. Black or African American10
5. Native Hawaiian or Other Pacific Islander0
6. White41
7. Two or more races4
8. Race/ethnicity unknown8

D. Living Arrangements of Individuals Served

Multiple responses not permitted.

1. Independent2
2. Parental or other family home15
3. Community residential home3
4. Foster care0
5. Nursing home37
6. Public institutional living arrangement1
7. Private institutional living arrangement1
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 impairment1
2. Deaf/hard of hearing0
3. Deaf-blind1
4. Orthopedic impairment17
5. Mental illness0
6. Substance abuse0
7. Mental retardation0
8. Learning disability8
9. Neurological impairment12
10. Respiratory impairment4
11. Heart/other circulatory impairment8
12. Muscular/skeletal impairment4
13. Speech impairment0
14. AIDS/HIV2
15. Traumatic brain injury0
16. Other disability6

Part IV. Systemic Activities and Litigation

A. Systemic Activities

1. Number of policies/practices changed as a result of non-litigation systemic activities0

2. Number of individuals potentially impacted by policy changes874,000

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.

Kentucky’s Waiver Statewide Transition Plan Federal rule changes to the home and community based services regulation have caused Kentucky to create a Waiver Statewide Transition Plan. The plan tells how Kentucky, over the next five years, will make all its home and community based waivers compliant with the amended federal rule. The changes will impact the Acquired Brain Injury Waiver, the Acquired Brain Injury-Long Term Care Waiver, the Home and Community Based Waiver, the Michelle P. Waiver, the Model Waiver II, and the Supports for Community Living Waiver. The amended federal rule requires waivers to have integrated residential settings, opportunities for competitive employment, participant engagement in community life, and autonomy and independence in making life choices. Kentucky P&A along with many other advocacy groups commented on the proposed transitional plan noting the need for more consumers input. The Department for Medicaid Services responded by scheduling public forums for providers and consumers as part of the final transition plan. Kentucky P&A’s comments can be viewed on its website at www.kypa.net and the final plan is available on Medicaid’s homepage — http://chfs.ky.gov/dms/ The public forums were held on February 17 in Prestonsburg, Kentucky and on February 19 in Florence, Kentucky. In letters to CMS, Kentucky P&A discussed nonresidential settings. On June 2, 2016 CMS said ““The new framework in Kentucky’s plan to rely on reverse integration strategies as a way for settings to comport with the HCBS settings rule appears to have impacted how the state assessed and categorized its non-residential settings. o Under the rule, with respect to non-residential settings providing day activities, the setting should ensure that individuals have the opportunity to interact with the broader community of non-HCBS recipients, and provide opportunities to participate in activities that are not solely designed for people with disabilities or HCBS beneficiaries that are aging but rather for the broader community. Settings cannot comply with the community integration requirements of the rule simply by only hiring, recruiting, or inviting individuals who are not HCBS recipients into the setting to participate in activities that a non-HCBS individual would normally take part of in a typical community setting. o Individuals receiving HCBS nonresidential services should be engaged in activities they choose, that reflect their individual interests and goals and simultaneously promote the individual’s desired level of community integration.” The following is a link to CMS’ initial approval of Kentucky’s plan: https://www.medicaid.gov/medicaid/hcbs/downloads/ky/ky-intl-approvl.pdf 1115 Medicaid Demonstration Waiver Proposal Kentucky P&A tracked and provided comments on Kentucky’s new 1115 Medicaid Demonstration Waiver proposal. The 1115 targets those individuals who became newly Medicaid eligible following the passage of the Affordable Care Act (ACA). Under the ACA and following a U.S. Supreme Court ruling, states could choose to expand Medicaid to those earning 138% of the federal poverty level or less. Kentucky choose to expand. The 1115 requires community engagement and premiums among other things. Kentucky P&A expressed concern that the 1115, while focusing on the expansion population, also included Supplemental Security Income (SSI) recipients. SSI recipients in Kentucky receive Medicaid and have done so long before the passage of the ACA. By including SSI recipients, the 1115 created burdens for the SSI population where none existed before. KY P&A asked Kentucky Medicaid to remove the SSI population from the 1115. We did so in person and in writing. The final version of the 1115 Kentucky submitted to the Center for Medicare and Medicaid services excluded SSI recipients from the 1115. Consequently, SSI recipients won’t have to pay premiums, participate in community engagement, and will receive Medicaid on a fee for service basis rather than via managed care. Home and Community Base Waiver- Pay Rate of Attendant Care Kentucky has recently been creating more and more barriers to those wanting to consumer direct their Medicaid wavier services and the recent changes to Kentucky’s waiver for those that meet nursing facility level of care (HCBW) continues this trend. Kentucky P&A commented on and testified about these changes to HCBW. We expressed concern that the pay rate for traditional attendant care services will be billed at more than double the rate for the same service provided by consumer directed choice. Additionally, as this is an existing waiver, many recipients that direct their care will be forced to dramatically cut the pay of their employees. This pay cut along with a tightening of allowing family members to provide care combined with forcing consumers to pay hundreds of dollars in per employee start-up costs makes it much more difficult for consumers to direct their care. As Kentucky P&A is consumer driven, and many consumers tell Kentucky P&A they want to direct their care, we will continue to advocate for removing these barriers to choice. Assisted the Department of Public Advocacy in Draft Comments to the 1115 Medicaid Proposal Kentucky P&A worked with various partners to educate state officials about the availability of suspending rather than terminating Medicaid benefits upon incarceration or placement in an Institution for Mental Disease (IMD). These comments were included in the draft comments to the 1115 Medicaid proposal. Kentucky added an additional status category that allows inmates to have their Medicaid benefits suspended. to suggest that persons incarcerated have their Medicaid benefits suspended rather than terminated. It has shown that recidivism is reduced and employment is increased if individuals have access to health care upon release from a jail or prison. The Able Act Kentucky Protection & Advocacy assisted in the passage of the Kentucky ABLE Act (Senate Bill 179). The Achieving a Better Life Experience (ABLE) Act allows individuals with disabilities to have savings accounts for disability-related expenses while keeping access to means-tested benefits like SSI and Medicaid. Unlike a special needs trust, the beneficiary of an ABLE account has control over the funds. Several of KY P&A’s PADD Board and PAC Council members expressed frustration at having to keep a bare minimum of savings in order to access benefits. Some of these members along with KY P&A met with Kentucky legislators and attended numerous roundtable meetings on the passage of the Senate Bill 179. An often cited example of the savings barrier involved consumers who could not afford to repair their modified vehicles so they could continue going to work or interacting with their community. Now that the Kentucky ABLE Act is law, Kentuckians with disabilities can open an ABLE account in any participating state and not be forced to have minimal savings in order to access benefits. Nursing Home Monitoring During FY 2016, Kentucky P&A completed the nursing home priority to monitor 100 nursing home facilities. Staff conducted onsite monitoring in sixty-five (65) nursing facilities throughout the Commonwealth. Monitoring sites were chosen from comprehensive mental health regions, from OIG surveys where Types A and B citations were found, and from facilities where Kentucky P&A had received Information & referral calls. At each facility Kentucky P&A staff meet with administrative, nursing and social work staff. We completed monitoring tools and toured the facilities. Staff explained our purpose for being at the facility and the Kentucky P&A mission. Kentucky P&A provided facility staff with information about the P&A system, Medicaid Waivers, KY Transitions (Money Follows the Person), Assertive Community Treatment, Integrated Supplement, PASRR II services and voting accessibility rights. For every topic P&A staff discussed, we left printed materials on the same. Kentucky P&A staff spoke to residents, some identified by nursing facility staff and others Kentucky P&A staff came across through touring the facility. Kentucky P&A gave residents information about P&A services, informed residents about Medicaid waiver services that could provide services for the resident to return to the community and inquired about the resident’s well-being. Kentucky P&A staff opened approximately 90 service requests on a variety of issues. The main issues were returning to the community with services, obtaining physical therapy services, obtaining PASRR II services, assistance with assistive technologies and resident’s rights. Participating in the Pritchard Committee Achievement Gap Study regarding children with disabilities in the public education system. After seeing tremendous progress in educational achievement in Kentucky since the 1990s, persist achievement gaps continue to exist for students with disabilities, students of color, and students with English as a second language. The Prichard Committee, a nonprofit organization that provides a public voice for improving education for all Kentuckians decided to embark on an achievement gap study with the end goal to issue a report of their findings and make recommendations. The study group consisted of parents, educators, superintendents, and teachers, directors of special education, business leaders and legislators. This study group met for about one year and brought in educators, parents, advocates and other professionals. KY Protection & Advocacy was invited to present information about the educating of students with disabilities. On November 17, 2015, Kentucky P&A advocate and Kentucky P&A attorney, presented information on students with disabilities and noted the disparities in discipline. P&A staff used a recent case to highlight the disparities in disciple of students with disabilities. After the presentation, Kentucky P&A staff had the opportunity to discuss our experiences working in Kentucky school districts with students with disabilities. Staff was able to provide information about how students with disabilities face harsher sanctions. In August 2016, The Prichard Committee issued its report entitled, “Excellence with Equity: It’s Everybody’s Business. The report made five findings: 1) Gaps are already visible at the start of kindergarten, making early childhood efforts essential. 2) Most gaps expand from kindergarten to graduation, confirming that improvement is needed at all grade levels. 3) Disciplinary consequences are much harsher for students of some races than for others. 4) Identification of students with disabilities and gifted and talented students appear to lack equity. 5) Kentucky’s teaching force lacks sufficient racial diversity. To meet the challenges of the findings, the Committee made six recommendations: 1) Bold leadership at the state level and in every community; 2) Accountability to drive substantial improvement in the performance of each student and student group; 3) School climate and culture that welcome and support each student and family; 4) Instruction in the classroom that engages each student in deep, effective learning opportunities; 5) Communities that band together to demand and support excellence with equity; and 6) Sustainability of reforms. The Prichard Committee report can be found at: http://prichardcommittee.org/wp-content/uploads/2016/08/2016-Achievement-Gap-Study-Group-Report.pdf Senate Bill 200, Juvenile Justice Reform Kentucky P&A attended legislative, oversight council, and other stakeholder meetings concerning the implementation of juvenile justice reform and how it may affect children with disabilities. Kentucky P&A educated interested stakeholders about the disproportionality that exists concerning the number of children with disabilities involved in the juvenile justice system compared to the number of children without disabilities that are involved in the juvenile justice system. Kentucky’s governmental agencies have started to look at existing data concerning children with disabilities who are involved in the juvenile justice system. Monitoring Special Management Units of the 13 State Prisons Kentucky P&A went to all of Kentucky’s Adult prisons in 2016. We developed a detailed monitoring tool which focused on inmates with disabilities in special management units, which are segregation cells where the inmate is in cell for 23 hours per day. We interviewed Wardens, other prison staff and all of the mental health treatment staff for the KY department of corrections regarding programs, concerns and treatment barriers. KY DOC provided us with statistical information about the special management units and individuals with disabilities. We also interviewed three inmates with disabilities per prison and opened records reviews for many of those interviewed. During monitoring Kentucky P&A provided comment on mental health policy, special management unit policy and other policies for corrections and we advocated for individual inmates with disabilities to be given more out of cell time, treatment and programming. The Rights and Responsibilities of Guardians Individuals with disabilities adjudicated under Kentucky guardianship law, even those that are fully adjudicated disabled, keep their rights and personal freedoms, limited only to the extent necessary for a guardian to provide needed care and services. Guardians must also seek the court’s permission before agreeing to such procedures like ECT, sterilization, and removing bodily organs. Even with these statutory protections, KY P&A actively encourages individuals and their families to exam alternatives to guardianship. This year we presented information about guardianship and the alternatives to guardianship at the Kentucky Association of Private Providers conference and at the Kentucky Guardianship Association conference. We also met with Kentucky’s judicial college to discuss issues that involve individuals with disabilities. Finally, Kentucky P&A helped facilitate the introduction of the concept of supported decision making to Kentuckians with disabilities and their guardians.

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.

Kentucky P&A did not have any litigation/class activities for PAIR eligible clients.

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.

I. Abuse, Neglect, and Exploitation Individual Advocacy 1.1 Kentucky P&A will investigate all suspicious deaths. The Internal Abuse Team (IAN) will review all reports of suspicious deaths made to Kentucky P&A or made aware to Kentucky P&A. Kentucky P&A opened 7 suspicious death investigations of PAIR eligible clients. 1.2 Kentucky P&A will investigate all serious injuries, including those sustained during the use of physical restraint/seclusion at schools and other facilities/community programs providing services to individuals with disabilities. IAN will review all reports made to or that P&A. Kentucky P&A opened 6 investigations of serious injuries, including those sustained during the use of physical restraints at schools and other facilities/community program, providing services to PAIR eligible individuals. Systemic Advocacy 1.3 IAN will review Type A/B Citations, incident reports, and other notices of alleged abuse/neglect/exploitation to determine further action, including conducting primary or secondary investigations. IAN received 46 allegations of abuse and neglect of PAIR eligible clients. Of the 46 allegations received, six incidents fell under IAN’s criteria to open as abuse and neglect investigations. This was in addition to the seven death investigations. The IAN Team used information provided by the facilities’ internal investigation units, the Office of Inspector General, the Department of Community Based Services, along with meeting the victim and reviewing records. 1.4 Kentucky P&A will participate in Project SAFE (Safety & Accessibility for Everyone) planning/educational/outreach efforts and implementation of the strategic plan and the Crisis Intervention Training (CIT) with the Louisville Metro Police and the state wide CIT program. Kentucky P&A continued participation in Project SAFE (Safety & Accessibility for Everyone), a multi-disciplinary network working to build the capacity of professionals throughout Kentucky to provide safe, accessible and comprehensive person-centered services to individuals with disabilities who have been subjected to sexual assault and/or domestic violence. During FY’16 Kentucky P&A: • P&A’s advocate representative continued role as co-chair of the statewide organization. To ensure balance in the collaboration leadership, one co-chair works in victim services while the other works in disability-related field. • P&A’s advocate representative was interviewed along with the General Counsel for the KY Coalition on Domestic Violence on Project SAFE for a two-page article in the Exceptional Family Magazine produced by the Commonwealth Council on Developmental Disabilities. • Worked with Project SAFE Executive Committee members to hold the 4rd Annual State-wide Advocating to End Abuse against People with Disabilities Summit held in Lexington. The over 80 professionals and self-advocates attended the event that focused on truths and myths regarding people who are domestic violence victims, sexual assault victims, and people with disabilities. The summit also focused on the new Kentucky Interpersonal Protective Orders and innovations in trauma focused therapy for people with developmental & intellectual disabilities • Based upon the P&A advocate representative’s work with Project SAFE, she was invited to do a presentation on the intersection of disability and youth entering into the juvenile justice system. The presentation was done at the “Juvenile Justice and Community System Summit: Collaborating to Increase Successful Mental Health Outcomes for Our Youth” in which 100 professionals from schools, law enforcement, mental health field, and attorneys attended. • Had an informational table at the Kentucky Attorney General’s Victim Assistance Conference. Eighty (80) people asked questions and 4 Information & Referral requests were taken. • Served on a panel of professionals providing feedback regarding role play to police officers participating in Crisis Intervention Team training for Louisville Metro Police Department recruits & veteran officers and state-level CIT for veteran officers. Participated in 7 trainings and provided feedback to 197 officers. • Participated in quarterly meetings of CIT Advisory Board for both Louisville Metro Police Department and State-wide CIT. • Kentucky P&A participated in a newly formed Kentucky Cabinet for Health and Family Services Advisory Committee that has a mission to improve services to domestic violence and sexual assault victims who are in demographically underserved populations. 1.5 Kentucky P&A will research options so that deaths in personal care homes are reported and reviewed. The Cabinet for Health and Family Services (CHFS), Kentucky Office of Health Policy publishes an Annual Long-term Care Report. This report is divided into Area Development Districts (ADD), Nursing Facilities, ICF-ID/DD, Alzheimer’s facilities, and Personal Care Homes. Kentucky P&A is notified of death of PCH resident’s that we represent. The report includes death census data for each PCH in Kentucky. This information is only available annually. Kentucky P&A receives notice of citations by the Office of Inspector General(OIG), however deaths in PCH rarely generate a citation and reviews are often cursory. P&A will work collaboratively with CHFS to address the frequency of reporting and review of deaths in PCHs as it relates to the Amended Settlement Agreement. 1.6 Kentucky P&A will create a memorandum gained under the monitoring efforts at a Level I Psychiatric Residential Treatment Facility (PRTF). Kentucky P&A created a draft memorandum gained under the monitoring efforts at a Level I Psychiatric Residential Treatment Facility, but before its release the Cabinet for Health and Family Services initiated an investigation into that facility and several other facilities owned by the same company. Corrective measures have been taken to address many of our concerns. Kentucky P&A remains concerned, however, by the facility’s historic inability to sustain meaningful change in its programs. Kentucky P&A will continue to closely monitor the facility and address any new or re-emerging issues as they arise. Case Summary: Kentucky P&A received a copy of a Type A Citation issued by the Office of Inspector General (OIG) to a nursing facility. The nursing facility received the Type A Citation for facility to note changes in BS’s condition and to act on these changes. Several Certified Nursing Assistants noted changes in BS’s condition and the family members noted changes to the staff. BS had diagnoses of Parkinson's, diabetes and leukemia. The facility failed to notify physician of changes in BS’s condition. There was no documentation that the physician was notified of fever, of coughing, of sunken cheeks and failure to urinate. About 12 hours later, BS was found unresponsive and in respiratory distress. He was taken to the hospital where he was intubated and placed on a ventilator.BS was admitted to the hospital with septic shock, aspiration pneumonia, dehydration, elevated liver function, acute kidney failure and hypernatremia. ER physician stated due to dehydration, this caused lack of blood flow to brain, causing a brain injury which could have been avoided BS died several days later. Kentucky P&A reviewed medical records, a plan of correction submitted by the facility to the OIG. The incident was reported by the Office of Inspector General to Adult Protective Services (APS), however, APS did not substantiate report of neglect. The facility began to audit 100% of resident’s charts to ensure physicians were notified of any changes in condition. The facility previously faxed changes of condition to the physician, however if the physician’s office was closed, this would prevent the notification in a timely manner. The facility changed its policy to call the physician. Kentucky P&A informed family of time limits if they chose to pursue legal action. The family of BS chose to retain an attorney to pursue legal action against the nursing facility. II. Olmstead/Community Integration Individual Advocacy 2.1 Kentucky P&A will represent or provide technical assistance to 3 PAIR eligible parents/guardians of children and/or adults living in a nursing home regarding services and supports available to allow them to live in a more integrated living arrangement. Strategies include filing OCR complaints. Kentucky P&A provided technical assistance to 3 PAIR eligible adults living in a nursing home regarding services and supports available to allow them to live in a more integrated living arrangement. 2.2 Kentucky P&A will represent 2 PAIR eligible adults with disabilities at risk of institutionalization and in need of community services and supports under Olmstead, who do not meet the above individual advocacy priorities. Kentucky P&A represented 1 PAIR eligible adult with disabilities at risk of institutionalization and in need of community services and supports under Olmstead, who do not meet other individual advocacy priorities. Systemic Advocacy 2.3 Kentucky P&A will continue to visit nursing facilities in each of the 14 Community Mental Health Center regions, up to 100 (1/3 of Kentucky’s nursing facilities) to obtain information and data regarding children and adults with disabilities living there to identify barriers to those individuals moving into the least restrictive environment. During FY 2016, Kentucky P&A completed the nursing home priority to monitor 100 nursing home facilities. Staff conducted onsite monitoring in sixty-five (65) nursing facilities throughout the Commonwealth. Monitoring sites were chosen from comprehensive mental health regions, from OIG surveys where Types A and B citations were found, and from facilities where Kentucky P&A had received Information & referral calls. At each facility Kentucky P&A staff meet with administrative, nursing and social work staff. We completed monitoring tools and toured the facilities. Staff explained our purpose for being at the facility and the Kentucky P&A mission. Kentucky P&A provided facility staff with information about the P&A system, Medicaid Waivers, KY Transitions (Money Follows the Person), Assertive Community Treatment, Integrated Supplement, PASRR II services and voting accessibility rights. For every topic P&A staff discussed, we left printed materials on the same. Kentucky P&A staff spoke to residents, some identified by nursing facility staff and others Kentucky P&A staff came across through touring the facility. Kentucky P&A gave residents information about P&A services, informed residents about Medicaid waiver services that could provide services for the resident to return to the community and inquired about the resident’s well-being. Kentucky P&A staff opened approximately 90 service requests on a variety of issues. The main issues were returning to the community with services, obtaining physical therapy services, obtaining PASRR II services, assistance with assistive technologies and resident’s rights. 2.4 Kentucky P&A will educate providers and recipients of Medicaid regarding their ability to suspend Medicaid benefits. Kentucky P&A worked with various partners to educate state officials about the availability of suspending rather than terminating Medicaid benefits upon incarceration or placement in an institution for mental disease (IMD). Kentucky added an additional status category that allows inmates to have their Medicaid benefits suspended. Kentucky P&A’s efforts to suspend Medicaid for those in an IMD are ongoing. Kentucky P&A continues to educate state officials, providers, and recipients about the benefits of suspending for the IMD population. Kentucky P&A has reached out to Kentucky Medicaid as well as the Department for Aging and Independent Living. Case Summary: RZ returned to the community with supports and services through the Kentucky Transitions program (Money Follows the Person) after being in a nursing facility for several years. RZ elected to participate in direct Home and Community Based services. Because of RZ’s disability, RZ had an increased risk of falling. After a fall Adult Protective Services (APS) became involved and suggested that RZ was not able to participate directing her services and suggested RZ was self-neglecting because of falls. APS suggested that RZ needed to return to a nursing facility in spite of RZ age of 51. Medicaid wanted to terminate participant directed services. RZ contacted Kentucky P&A. RZ wanted to stay in the community. RZ had an apartment and enjoyed life in the apartment complex. RZ ‘s HCB changed to traditional services and a relative became her healthcare representative. APS investigation ended as unsubstantiated self-neglect. Later, RZ was hospitalized because of the fall. The hospital wanted to place RZ in a nursing facility. RZ transferred to a rehabilitation facility and the facility wanted to place RZ in a nursing facility. RZ became a strong advocate for her wishes with the assistance of a relative and P&A. RZ let her wished be known and RZ returned to the community. RZ suffered two additional medical emergencies. During these emergencies it was discovered that an important medication had been accidently stopped and that certain medical problems RZ was having had a remedy. These revelations came about because RZ went to a different hospital. The doctors, nursing staff and social worker understood RZ was competent to make decisions about RZ’s life. This medical facility respected RZ’s wishes. The hospital helped RZ know what information to provide to medical staff at hospitals and worked with RZ to improve health outcomes. RZ continues to enjoy life in the community. III. Education Individual Advocacy 3.1 Kentucky P&A will represent at least one PAIR eligible child/youth in public schools who have inappropriate Individualized Education Program (IEP) or who are placed in an inappropriate educational setting. This priority will include children/youth who qualify for special education, but who are not receiving any special educational services; children for whom an IEP and or Behavior Intervention Plan (BIP) is not implemented as written; children for whom a district has failed to complete a Functional Behavioral Analysis (FBA) or manifestation determination Hearing (MDH); children inappropriately restrained or secluded; and children/youth who have not received appropriate transition planning (including vocational and technical school and supported employment). Kentucky P&A represented three PAIR eligible children/youth in public schools who had an inappropriate IEP or who were placed in an inappropriate educational setting. 3.2 Kentucky P&A will complete reviews of the education records of at least one child/youth in public schools with disabilities and determine if there has been a violation of the child/youth’s educational rights under state and/or federal law. Preference will be given to children/youth in institutions. Kentucky P&A reviewed the educational records of 3 PAIR eligible children/ youth in public schools with disabilities to determine if there was a violation of the children/youth’s educational rights under state and/or federal law. Systemic Advocacy 3.3 Kentucky P&A, along with The Arc of Kentucky and KYSPIN, will provide 3 trainings to parents/grandparents/foster parents on Special Education and related topics across Kentucky. Kentucky P&A staff along with the Arc of Kentucky and Kentucky Special Parent Involvement Network (KySPIN) provided training that covers an overview of IDEA, the Guidance document for developing an Individualized Education Plan (IEP), information on preparing for meetings, working as part of a team and being an effective advocate. The training includes both lecture and participatory activities. Information is available to participants including several Kentucky P&A publications including Partners in Advocacy, How to Negotiate in ARC meetings, one page informational sheets on transition and evaluation, Kentucky P&A’s Your Voice: Your Vote booklet and Going to work and Keeping Benefits book. The feedback from the training included that participants felt they received clear, concise information, helpful resources, the small group settings allowed for questions and answers and understanding what to include in an IEP. 3.4 Kentucky P&A will develop a one-page publication on the use of service animals in schools. During the previous fiscal year Kentucky P&A received multiple calls regarding issues with service dogs in school settings. P&A successfully resolved issues with accommodating service animals and noted that parents and families were often uncertain how to address service dog accommodations. A one-pager was created to provide general information on addressing service dogs in school settings. 3.5 Kentucky P&A will participate in the Pritchard Committee Achievement Gap Study regarding children with disabilities in the public education system. After seeing tremendous progress in educational achievement in Kentucky since the 1990s, persistent achievement gaps continue to exist for students with disabilities, students of color, and students with English as a second language. The Prichard Committee, a nonprofit organization that provides a public voice for improving education for all Kentuckians decided to embark on an achievement gap study with the end goal to issue a report of their findings and make recommendations. The study group consisted of parents, educators, superintendents, and teachers, directors of special education, business leaders and legislators. This study group met for about one year and brought in educators, parents, advocates and other professionals. KY Protection & Advocacy was invited to present information about the educating of students with disabilities. On November 17, 2015, Kentucky P&A advocate and Kentucky P&A attorney, presented information on students with disabilities and noted the disparities in discipline. P&A staff used a recent case to highlight the disparities in discipline of students with disabilities. After the presentation, Kentucky P&A staff had the opportunity to discuss our experiences working in Kentucky school districts with students with disabilities. Staff was able to provide information about how students with disabilities face harsher sanctions. In August 2016, The Prichard Committee issued its report entitled, “Excellence with Equity: It’s Everybody’s Business. The report made five findings: 1) Gaps are already visible at the start of kindergarten, making early childhood efforts essential. 2) Most gaps expand from kindergarten to graduation, confirming that improvement is needed at all grade levels. 3) Disciplinary consequences are much harsher for students of some races than for others. 4) Identification of students with disabilities and gifted and talented students appear to lack equity. 5) Kentucky’s teaching force lacks sufficient racial diversity. To meet the challenges of the findings, the Committee made six recommendations: 1) Bold leadership at the state level and in every community; 2) Accountability to drive substantial improvement in the performance of each student and student group; 3) School climate and culture that welcome and support each student and family; 4) Instruction in the classroom that engages each student in deep, effective learning opportunities; 5) Communities that band together to demand and support excellence with equity; and 6) Sustainability of reforms. The Prichard Committee report can be found at: http://prichardcommittee.org/wp-content/uploads/2016/08/2016-Achievement-Gap-Study-Group-Report.pdf Case Summary: WM is a 4th grade student at a private elementary school in Jefferson County, Kentucky who has a peanut allergy. The school previously did not have a school-wide allergy policy. Kentucky P&A worked with WM’s mother to draft an allergy policy to submit to the school’s parent council that would meet the needs of student’s grades K-8. The policy was developed and submitted. At the start of the school year, the school implemented the policy it had adopted, which was similar (but not identical) to the policy submitted by WM’s mother. WM’s mother was pleased with the development and enactment of the new policy. Case Summary: AW is an eight-year-old child who has diagnoses of developmental disability, ADHD-PI (Primarily Inattentive). AW receives Related Services in the areas of Speech and Occupational Therapy. AW has had an IEP for three years and attends an elementary school in Clark County. His IQ dropped 40 points and he has not shown academic progress. His mother indicated that his grades are flat, MAP scores have declined, and he is still at a Kindergarten level. She also indicated he has had the same IEP for 3 years with the same goals and objectives. AW’s parents requested all records to map out the data and found there wasn't any data available, with the exception of his Speech Services, which is the only area AW has shown any progress. His mother was given data for the first time in May 2015 with data reflected from February 2015-May 2015. A 2012 Psychological Evaluation indicated AW’s IQ to be a 97 (Average Range) and parents were informed (at an ARC): "AW should progress at the same level as peers." A Psychological report from October 2015, indicated AW's IQ is 57 and he is "Intellectually Disabled." Kentucky P&A reviewed AW’s records to determine if he had the same IEP goals for 3 years, which he did not. Kentucky P&A provided guidance on resolving issues with the school, support for ARC preparations, and guidance to have an appropriate IEP developed. As a result of support from Kentucky P&A, AW now has an appropriate IEP and is making progress on his IEP goals. His teachers are using teaching strategies to benefit AW's need for a multi-sensory approach to learning, and Extended School Year services were granted for the 2015-2016 school year. IV. Health Care Individual Advocacy 4.1 Kentucky P&A will represent at least 1 PAIR Medicaid eligible adults, who are denied medical, dental, and other health services or whose services are reduced or terminated. Kentucky P&A represented 2 PAIR eligible adults who were denied medical, dental, and other health services or whose services were reduced or terminated. 4.2 Kentucky P&A will represent at least 1 PAIR Medicaid eligible child/youth with disabilities relating to their denial of or inability to access healthcare services, including physical and behavioral health services. Priority will be given to those children/youth committed to or at-risk of commitment to DCBS solely for purpose of obtaining services. Kentucky P&A represented 1 PAIR Medicaid eligible child/youth with disabilities relating to their denial or inability to access healthcare services, including physical and behavioral health services. Systemic Advocacy 4.3 The PADD Advisory Board will educate legislators about the impact of Medicaid waiver changes and advocating for policy revisions regarding changes to Kentucky’s Medicaid waivers with specific focus on Participant Directed Services (PDS) changes and the impact to persons who choose the PDS option. Members of the PADD Advisory Board met and/or corresponded with their state Representatives and Senators about the impact of changes to three of the state’s Medicaid waivers. They created a one-pager of information to leave with their Legislators that included information about Kentucky P&A, Kentucky PADD Advisory Board, and detailed information about themselves. Issues they discussed with their Legislators included paying pre-employment cost to self-direct their waiver services, advocating for the ABLE ACT to be passed in Kentucky, and concerns with waiver waitlist. 4.4 Kentucky P&A will create informational material (1-pager, web article, newsletter article) on the system of care changes and how they relate to consumers of services (i.e. waiver waiting lists, EPSDT, and movement of behavioral health services to managed care and new providers. Kentucky P&A advised consumers of services about the ongoing changes in Kentucky’s mental health system for children called the system of care by writing an article in its spring newsletter. Kentucky’s consumers were informed that Kentucky’s Department for Medicaid Services is now allowing providers who historically could not have billed to Kentucky’s Medicaid System now can and steps are being taken to determine where services are available and where services are not available in Kentucky. Consumers were also made aware that they could request a case manager or care coordinator from the managed care organizations to assist them in coordinating and receiving services. People with disabilities were able to coordinate and access mental health services since Kentucky P&A informed the public about the changes. 4.5 Kentucky P&A will create informational material (1-pager, web article, newsletter article) on the new law relating to the delegation of nursing duties as they relate to the administration of insulin and g-tube care. Kentucky P&A created a draft one-page information sheet about the new law relating to the delegation of nursing duties as they relate to the administration of insulin and g-tube care. It is not yet complete, but will be complete in FY 2017. Case Summary: LL is now 16-year-old female who lives in Christian County, Kentucky. LL has a rare genetic disease, McCune-Albright Syndrome, which manifests itself primarily through a bone disease that converts healthy bone tissue to fragile damaged tissue. This damage, which is spread throughout LL’s skeletal system, makes her bones brittle and susceptible to breaks and fractures. It can also lead to disfigurement in the affected areas as the bones may grow abnormally. Due to the rarity and severity of her condition, LL (who is a Medicaid recipient) had been seen by an orthopedic specialist for her condition in Florida. When LL was 13, Kentucky P&A began to contact the Medicaid program with Managed Care Organizations (MCOs). LL’s MCO denied her claim for a follow-up visit with her specialist. Kentucky P&A filed an administrative appeal. Kentucky P&A appealed on several issues, including the fact that the denying doctor did not have the requisite clinical expertise to deny the claim. The appeal was submitted to the hearing officer on pre-hearing motions and the hearing officer’s recommended opinion overturned the denial. The Cabinet Secretary, however, upheld the denial. Kentucky P&A appealed that denial to the Franklin Circuit Court. The Franklin Circuit Court held that the doctor did not have the requisite experience to deny the claim and overturned the denial. LL was able to get a follow-up appointment with her specialist. V. Criminal Justice Individual Advocacy 5.1 Kentucky P&A will provide technical assistance on ALL cases to Department of Public Advocacy (DPA) attorneys representing PAIR eligible youth or adults with disabilities who interface with the criminal justice system and request assistance. Kentucky P&A provided technical assistance to a DPA attorney representing 1 PAIR eligible adult who interfaced with the criminal justice system and requested assistance. Systemic Advocacy 5.2 Kentucky P&A will monitor the implementation of SB 200, juvenile justice reform. Kentucky P&A attended legislative, oversight council, and other stakeholder meetings concerning the implementation of juvenile justice reform and how it may affect children with disabilities. Kentucky P&A educated interested stakeholders about the disproportionality that exists concerning the number of children with disabilities involved in the juvenile justice system compared to the number of children without disabilities that are involved in the juvenile justice system. Kentucky’s governmental agencies have started to look at existing data concerning children with disabilities who are involved in the juvenile justice system. 5.3 Kentucky P&A will continue to monitor the 13 Kentucky Department of Corrections facilities and units where individuals with SMI or other disabilities are housed in segregation or other special management units, including the mental health care treatment that is available to incarcerated individuals. This may include requesting and reviewing records and meeting with DOC. Kentucky P&A monitored all of Kentucky’s Adult state prisons in 2016. A detailed monitoring tool was developed which focused on inmates with disabilities in special management units, which are segregation cells where the inmate is in cell for 23 hours per day. Kentucky P&A interviewed Wardens, other prison staff and all of the mental health treatment staff for the Kentucky Department of Corrections (DOC) regarding programs, concerns and treatment barriers. Kentucky DOC provided Kentucky P&A with statistical information about the special management units and individuals with disabilities. Kentucky P&A also interviewed three inmates with disabilities per prison and opened records reviews for many of those interviewed. During monitoring Kentucky P&A provided comment on mental health policy, special management unit policy and other policies for corrections and we advocated for individual inmates with disabilities to be given more out of cell time, treatment and programming. 5.4 Kentucky P&A will collaborate with Kentucky Department of Corrections to update the Reentry Resource Manual. In 2013, Kentucky P&A collaborated with the Kentucky Department of Corrections (DOC) to issue a Resource Reentry Manual that included resources about employment, housing, social services, behavioral health services, vocational services, crisis information, and health information. Kentucky P&A continues to collaborate with DOC to update resources for the manual. 5.5 Kentucky P&A will research methods for having ACA connectors available to persons currently incarcerated. Kentucky’s Executive Branch decided to abolish Kynect in 2016 and move Kentucky onto the federal exchange. Prior to this decision, Kynectors were visiting several jails to help inmates sign-up for healthcare benefits. KY P&A sought to determine if the interaction between Kynectors and those incarcerated could be strengthened. The decision to abolish Kynect ultimately impacted this priority. Kentucky is also seeking an 1115 Waiver aimed at the Affordable Care Act Medicaid expansion population. Case Summary: CK was an inmate in a state prison in Kentucky who was suffering from cancer. CK contacted P&A with assistance because he had been experiencing delays in treatment due to bad scheduling and a lack of transportation being provided by the prison due to a staffing shortage. Kentucky P&A requested CK’s records from the prison and reviewed those records concerning the alleged complaints and the records confirmed that CK had missed appointments. Kentucky P&A also reviewed records concerning grievances filed by CK, which is the only remedy provided to inmates outside of litigation to resolve inmate concerns. CK’s grievances were addressed and new appointments scheduled. The prison also set a protocol for CK so that if an appointment was missed CK would alert the nurse immediately. CK was also referred to private counsel if he chose to pursue any kind of damages claim. VI. Protect, Promote, and Exercise Rights Individual Advocacy 6.1 Kentucky P&A will represent at least 1 PAIR eligible individual with disabilities, who is discriminated against related to their disability, in matters related to housing, post-secondary, employment, and other, including access to goods/services/program provided by governmental agencies or entities. Kentucky P&A represented 2 PAIR eligible adults with disabilities who were discriminated against related to their disability, in matters related to access to goods/services/program provided by governmental agencies or entities. Systemic Advocacy 6.2 Kentucky P&A will contact state guardianship regarding the number of emergency guardianship orders and due process issues. Kentucky P&A obtained information on state emergency guardians from the Department of Independent Agency within the Cabinet for Health and Family Services. Kentucky P&A will continue to review the appointment of state emergency guardians. 6.3 Kentucky P&A will create business card on individual rights. Kentucky Protection & Advocacy created a pocket size pamphlet on individual rights in a psychiatric hospital outlining patient rights along with resources such as Public Defenders numbers across the state and all the Regional Community Mental Health Centers in the state. It also has helpful resource numbers on Advance Directives, information on Guardianship, and where to get information on the Amended Settlement Agreement and State Supplementation Program. The pamphlets are to be printed and distributed to the four state psychiatric hospitals in Kentucky as well as to the state’s personal care homes. 6.4 Kentucky P&A will explore options of informing guardians of their rights and responsibilities under Kentucky guardianship law. Individuals with disabilities adjudicated under Kentucky guardianship law, even those that are fully adjudicated disabled, keep their rights and personal freedoms, limited only to the extent necessary for a guardian to provide needed care and services. Guardians must also seek the court’s permission before agreeing to such procedures like ECT, sterilization, and removing bodily organs. Even with these statutory protections, KY P&A actively encourages individuals and their families to exam alternatives to guardianship. This year we presented information about guardianship and the alternatives to guardianship at the Kentucky Association of Private Providers conference and at the Kentucky Guardianship Association conference. We also met with Kentucky’s judicial college to discuss issues that involve individuals with disabilities. Finally, Kentucky P&A helped facilitate the introduction of the concept of supported decision making to Kentuckians with disabilities and their guardians. Case Summary: A long term care ombudsman contacted Kentucky P&A because the local emergency medical services refused to transport a nursing home resident to medical appointments. MC is a 58-year-old woman whose weight exceeds 700 pounds. She also has multiple health concerns including cellulitis, diabetes and respiratory failure. EMS refused services based on the railings would not lock in place on the side of the gurney and MC is too large for the EMS workers to move around and provide care in the back of the ambulance. EMS stated they would only transport her for emergency care but not to doctors’ appointments. MC is not able to go to doctors’ appointments for wound care. MC stated the EMS staff offered to place straps over her, however, she did not feel secure with this method of placing her on the gurney. Kentucky P&A contacted the EMS for the county where MC receives services. They agreed to accommodate her and found a gurney that would accommodate her size. MC states the rails are tight and she feels safe during the transport to her medical appointments. VII. Employment Individual Advocacy 7.1 P&A will represent at least one PAIR eligible child/youth with disabilities in need of transition services from a public high school to post-secondary settings, including vocational and technical school, and supported employment. Kentucky P&A represented 1 PAIR eligible youth with disabilities in need of transition services from a public high school to a post-secondary setting, including vocational and technical school, and supported employment. Case Summary: BG is a 16-year-old male with a diagnosis of ADHD. He expressed to Kentucky P&A that he had an interest in vocational services. BG’s mother contacted Kentucky P&A because the school was not told he would need to take prerequisite classes before he could go into the cooperative for agriculture classes. Kentucky P&A attended the Admissions and Review Committee (ARC) meeting and invited the Office of Vocational Rehabilitation (OVR)to attend the meeting. BG has changed his vocational focus several times, causing a delay in completing classes needed to graduate from high school. Kentucky P&A staff worked with BG, mother, OVR and school to come up with an Individualized Education Plan (IEP) that would outline classes needed to graduate. BG felt his diagnosis was keeping him form staying on track to complete his classes. After many meetings and working with OVR, BG is on target to graduate and to complete vocational training in agricultural classes. IX. Outreach Individual Advocacy 8.1 Kentucky P&A will represent two PAIR eligible individuals from underserved disability, minority, or geographic groups/populations. Kentucky P&A represented 2 PAIR eligible adults and one PAIR eligible child. Systemic Advocacy 8.2 Kentucky P&A will participate in the Relay for Life Event in Frankfort. Kentucky P&A participated in monthly fundraising activities for Relay for Life and participated in the annual Relay for Life Event in Franklin County, Kentucky. 8.3 Kentucky P&A will participate in two non-disability related outreach events. Kentucky P&A participated in two non-disability related events, providing information about Kentucky P&A and PABSS. One was the Frankfort Relay for Life event and the other was at the Latino, Immigrant and Refugee Summit hosted by the Kentucky Commission on Human Rights. 8.4 Kentucky P&A will continue to have a DRA stationed in DPA field office in Prestonsburg. Since November 2012, P&A has had a disability rights advocate at the DPA office located in Prestonsburg, KY. This initiative is to increase the visibility of P&A and increase the number of individuals served by P&A in the eastern part of the state, an underserved geographic population. Through this presence, we have increased our direct client representation, educated service providers on rights related issues, and provided training/resources to persons with disabilities. Since relocating, the disability rights advocate has contacted numerous facilities and programs in this 24 county region to discuss how best to deliver information about P&A and rights related information to the people with disabilities and those who support them. Over 70 regional facilities/programs have received letters about this new P&A outreach effort and seven disability rights related information presentations have been given to over 100 people with disabilities and/or disability related support staff. The counties included in this outreach effort are as follows: Boyd, Breathitt, Carter, Clay, Elliott, Floyd, Greenup, Harlan, Johnson, Knott, Lawrence, Lee, Leslie, Letcher, Lewis, Magof?n, Martin, Menifee, Morgan, Owsley, Perry, Pike, Rowan, and Wolfe. Case Summary: BF is an eight-year-old child who is muilti-racial and lives in rural eastern Kentucky, an underserved area of the state. He is diagnosed with ADHD, Mood Disorder and has a vision disability. He has an Individual Education Plan (IEP) under the category of Developmental Disability. The school system wanted to reevaluate BF, however his mother wanted an independent evaluation because she did not think that she could get an impartial one since the evaluator worked at the school. BF’s mother was concerned that several of her son’s behaviors which included crying and throwing his shoes were not addressed in the IEP. Kentucky P&A agreed to represent BF. This included attending several IEP meetings. Kentucky P&A assisted in getting an IPAD for BF and the IEP team formulated a behavior plan to address the crying. BF was also changed to another bus to address the throwing of shoes on the bus. The case was closed when all of BF’s issues were addressed in his IEP and there was no longer a rights violation.

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.

Abuse, Neglect, and Exploitation Individual Advocacy Kentucky P&A will investigate all *suspicious deaths. The IAN Team will review all reports of suspicious deaths reported to P&A or that P&A becomes aware via The Office of Inspector General media reports, monitoring efforts, etc. The IAN Team will send, as appropriate, to team leaders for case opening/assignment. Kentucky P&A will investigate all *serious injuries, including those sustained during the use of physical restraint/seclusion at schools and other facilities/community programs providing services to individuals with disabilities. The IAN Team will review all reports made to P&A or made by other entities, including The Office of Inspector General, media outlets, and monitoring efforts. Systemic Advocacy Internal Abuse and Neglect Team (IAN) will review Type A/B Citations, incident reports, and other notices of alleged abuse/neglect/exploitation to determine further action, including conducting primary or secondary investigations. Kentucky P&A will participate in Project SAFE (Safety & Accessibility for Everyone) planning/educational/outreach efforts and implementation of the strategic plan and the Crisis Intervention Training (CIT) with the Louisville Metro Police and the state wide CIT program. Kentucky P&A will work with the Kentucky Commission for the Deaf and Hard of Hearing and the Department of Behavioral Health Developmental and Intellectual and Developmental Disabilities to create an informative video presentation in American Sign Language to inform the deaf and hard of hearing community of the services available through P&A and identify opportunities for collaboration and the sharing of resources. Olmstead/Community Integration Individual Advocacy Kentucky P&A will represent or provide TA to parent/guardian of 2 children (1 state/1pvt) and 8 adults living in a nursing home regarding services and supports available to allow them to live in a more integrated living arrangement. Strategies include filing OCR complaints. Kentucky P&A will represent or provide technical assistance to12 adults with disabilities at risk of institutionalization and in need of community services and supports under Olmstead, who do not meet the above individual advocacy priorities. Systemic Advocacy Kentucky P&A will analyze data collected from 100 nursing facility visits during FY 2015 and FY 2016. P&A will meet with the Long Term Care Ombudsmen in all 15 Districts to continue to educate the ombudsmen about available services to assist residents in the successful transition to the community. P&A will also meet with the volunteer ombudsmen. Education Individual Advocacy Kentucky P&A will represent at least 11 children/youth in public schools who have inappropriate Individualized Education Program (IEP) or who are placed in an inappropriate educational setting. This priority will include children/youth who qualify for special education, but who are not receiving any special educational services; children for whom an IEP and or Behavior Intervention Plan (BIP) is not implemented as written; children for whom a district has failed to complete a Functional Behavioral Analysis (FBA) or manifestation determination Hearing (MDH); children inappropriately restrained or secluded; and children/youth who have not received appropriate transition planning (including vocational and technical school and supported employment). Kentucky P&A will complete reviews of the education records of 10 children/youth in public schools with disabilities and determine if there has been a violation of the child/youth’s educational rights under state and/or federal law. Preference will be given to children/youth in institutions. Kentucky P&A will provide technical assistance to the parent/guardian/caseworker of 25 children/youth with disabilities regarding addressing violations of the child’s educational rights. Systemic Advocacy Kentucky P&A will provide information to The Arc of Kentucky and KYSPIN to be included in trainings parents/grandparents/foster parents on Special Education and related topics across Kentucky. Kentucky P&A will investigate current resources available throughout the state to parents regarding educational advocacy, identify gaps in available resources, and strategize and implement ways to increase comprehensive access to information and resources necessary for parents to effectively advocate for the educational rights of their children. Kentucky P&A will present and/or post online a training regarding special education services for children with Specific Learning Disabilities. Health Care Individual Advocacy Kentucky P&A will represent 5 Medicaid eligible adults, who are denied medical, dental, and other health services or whose services are reduced or terminated. Kentucky P&A will represent 5 Medicaid eligible children/youth with disabilities relating to their denial of or inability to access healthcare services, including physical and behavioral health services. Priority will be given to those children/youth committed to or at-risk of commitment to DCBS solely for purpose of obtaining services. Criminal Justice Individual Advocacy Kentucky P&A will provide technical assistance on all cases to DPA attorneys representing youth or adults with disabilities who interface with the criminal justice system and request assistance. Kentucky P&A will monitor the cases of 3 children with disabilities impacted by SB200. Systemic Advocacy Kentucky P&A will continue to monitor the implementation of SB 200, juvenile justice reform and investigate the ongoing changes to the juvenile justice system. Kentucky P&A will collaborate with Kentucky Department of Corrections to update the Reentry Resource Manual. Kentucky P&A will summarize the information gathered during FY 2016 prison monitoring of metal health units and restrictive housing units. Kentucky P&A will monitor four county jails, one in the eastern, western, central and northern regions of the state. Kentucky P&A will monitor the Kentucky Correctional Psychiatric Complex. Protect, Promote, and Exercise Rights Individual Advocacy Kentucky P&A will represent 7 individuals with disabilities, who are discriminated against related to their disability, in matters related to housing, post-secondary, employment, and other, including access to goods/services/program provided by governmental agencies or entities. Systemic Advocacy Kentucky P&A will update the webpage daily during the legislative session regarding legislation that may or will impact individuals with disabilities. Outreach Individual Advocacy Kentucky P&A will represent 10 individuals from underserved disability, minority, or geographic groups/populations. Systemic Advocacy Kentucky P&A and the PAIMI Council will participate in fundraising efforts to support Relay for Life and will participate in the annual Relay for Life Event in Frankfort. Kentucky P&A will participate in two non-disability related outreach events. Kentucky P&A will continue to have a DRA stationed in DPA field office in Prestonsburg. Kentucky P&A will work with the Kentucky Commission for the Deaf and Hard of Hearing and the Department of Behavioral Health Developmental and Intellectual and Developmental Disabilities to create an informative video presentation in American Sign Language to inform the deaf and hard of hearing community of the services available through P&A and identify opportunities for collaboration and the sharing of resources.

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

Total Personnel Costs: $202,568.71 Rentals n/otherwise class-1009 $20.00 Advertising:0 Janitorial: 0 Food Products: 0 In-State Travel: $984.23 Out of State Travel: $32.00 Travel for non state employee: 41.60 Filing Fees and Court Costs (Legal Services): 0 Dues and Subscriptions:$1,000 Printing Paid to State Agency: $54.31 Telephone:0 Employee Training:0 Total Expenses:$204,700.85 There are 3.5 full time PAIR Support and staff persons employed at Kentucky P&A. While Kentucky PA staff members participate on a number of advisory boards and councils via other state agencies, Kentucky P&A does not have a board or council that is solely devoted to PAIR activities. There were not any grievances filed under PAIR in FY 2016. Kentucky P&A interfaces on a regular basis with the State Long Term Care Program through participation on multiagency meetings and councils and referrals from the long term care ombudsman concerning residents residing in long term care facilities. Kentucky P&A has a positive working relationship with this office. Many PAIR referrals are made to Kentucky P&A by the state long term care program. Jeff Edwards, Director of Kentucky P&A, meets regularly with the State Long Term Care Ombudsperson. Kentucky P&A works collaborates with the Client Assistance Program and makes referrals to assist clients of the Office of Vocational Rehabilitation, Office for the Blind, Independent Living Centers, Projects with Industry or employment programs in the state of Kentucky in identifying and receiving services.

Certification

Signed?Yes
Signed ByJeff Edwards
TitleKentukcy Protection and Advocacy Director
Signed Date11/30/2016