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

Kentucky (KENTUCKY OFFICE FOR PUBLIC ADVOCACY - P and A DIVISION) - H240A170018 - FY2017

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 areas9
2. Individuals receiving I&R outside PAIR priority areas270
3. Total individuals receiving I&R (lines A1 + A2)279

B. Training Activities

1. Number of trainings presented by PAIR staff26
2. Number of individuals who attended training (approximate)387

Kentucky P&A provided training at the Kentucky Equal Justice Center, Health and Welfare Task force In Fayette County about changes to the Home and Community Base Waiver, to Build Inclusion in Fayette County regarding predetermination, and at the Arc of Kentucky annual conference on guardianship in Jefferson County. Training was also provided to Independence Place Friends for Life and students of Human Development Institute in Fayette County about Kentucky Protection and Advocacy services. Information about the ABLE Act and STABLE Accounts was provided in Marshall County and to residents of 15 personal care homes throughout the state. Kentucky P&A provided information about services for PAIR eligible clients at the Anderson County Transition Fair in Anderson County, the Attorney General’s Advocacy Conference in Franklin County and the ADA’s 27th Anniversary Celebration in Jefferson County. Kentucky P&A participated in monthly fundraising activities for Relay for Life and participates in the annual event in Franklin County. Bottom Dollars, a documentary by Rooted in Rights Kentucky Protection & Advocacy (P&A) with assistance from Kentucky’s Developmental Disability Network hosted a screening of Bottom Dollars, a documentary by Rooted in Rights, which exposes segregated workplaces and low wages to people with disabilities. Following the screening, a panel discussion was held that included: Jordon Melograna, Director of Bottom Dollars; Cheryl Bates-Harris, National Disability Rights Network; Katie Wolf-Whaley, KY APSE; Jeff Edwards, Director of KY P&A, and Lisette Johnson, KY P&A advisory board member and Self-Advocate. The event was held in Somerset, Ky. Introductions were made by state Senator Girdler and the panel was facilitated by Bev Harp, a self-advocate and employee of KY’s University Centers on Excellence on Developmental Disabilities. There were over 50 attendees including self-advocates, family members, providers of services, local public officials, and others.

C. Information Disseminated to the Public

1. Radio and TV appearances by PAIR staff2
2. Newspaper/magazine/journal articles7
3. PSAs/videos aired0
4. Hits on the PAIR/P&A website103,402
5. Publications/booklets/brochures disseminated325
6. Other (specify separately)0

Narrative

Collaboration with the Kentucky Department of Corrections In 2013, Kentucky P&A in collaboration with the Kentucky Department of Corrections (DOC) issued a Resource Reentry Manual that included resources about employment and vocational rehabilitation services. Kentucky P&A continues to collaborate with the DOC to update resources for the manual. Since November 2012, Kentucky P&A has had a disability rights advocate at the DPA office located in Prestonsburg, however in 2017, the disability rights advocate sought other employment and is no longer an employee of Kentucky P&A. This initiative was effective increasing the visibility of and number of individuals served by P&A in the eastern part of the state, an underserved geographic population. 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. Public Comments Kentucky Protection and Advocacy distributed public comment forms addressing priorities for FY 2018. Participants were asked to comment on Kentucky P&A’s current priorities, identify areas of concern for individuals with disabilities, and concerns that Kentucky P&A should address. They were also asked to identify if they were a person with a disability or self-advocate an advocate on behalf of a person with a disability, an advocate on behalf of a family member with a disability a services provider, family member or other interested person. Abuse/Neglect, Healthcare, Community Supports, ADA/Section 505, and Education were identified as Kentucky P&A’s top five priorities. Other areas of concern also mentioned were affordable housing, transportation, abolition of restraint and seclusion, guardianship, employment, transition services, expanded outreach, monitoring of facilities, assistive technology, and voting access. There were 202 respondents. Persons with disabilities accounted for the majority of the respondents and 198 respondents stated Kentucky P&A should continue to work on the current priorities. Social Media Kentucky P&A 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. The website hits for Kentucky P&A’s website was 103,402 in fiscal year 2017. Kentucky P&A also monitored 12 nursing facilities, reviewed Kentucky’s compliance with PASSR, presented on ABLE Accounts, met with state guardianship about state wards who are clients of Kentucky P&A, attended National Consumer Voice for Long Term Care for Elderly, attended conference on Justice in Aging, Income Counting for Government Benefits, and presented on changes to HCBW for the KY Equal Justice Center's Health and Welfare Task Force. Kentucky P&A also serves on the following Boards and Councils: Office of Vocational Rehabilitation Interagency Council State Child Fatality Review Committee State Mortality Review Committee Kentucky Partnership for Families and Children State Elder Abuse Committee Jefferson County Regional Interagency Transition Team Kentucky Voices for Health State Help America Vote Act (HAVA) Advisory Committee Kentucky Assistive Technology Service (KATS) Advisory Board Medicaid Advisory/Technical Assistance Board Project Safe and Accessibility for Everyone Project 874K Planning Committee State Olmstead State Planning Committee Olmstead Committee and Continuity of Care Meetings at the four public state hospitals Kentucky Interagency Transition Council &Youth/Family Involvement/Leadership Committee Volunteer Organizations Active in Disaster (VOAD) Alternate Assessment Advisory Board Up in Kentucky State Interagency Council (SIAC) Quarterly regional meetings of the Long Term Care Ombudsman, Office of the Inspector General (OIG), Department for Community Based Services (DCBS), Department for Aging and Independent Living (DAIL), and the Attorney General’s office: Crisis Intervention Training Advocates for Community Options Kentucky Prevention Advisory Committee Trauma Group in Jefferson County 843 Region VI Council Statewide Olmstead Meetings Amended Settlement Agreement meeting with the Cabinet for Health and Family Services RevUp Kentucky

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)33
2. Additional individuals served during the year27
3. Total individuals served (lines A1 + A2)60
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 26

C. Problem Areas/Complaints of Individuals Served

1. Architectural accessibility0
2. Employment2
3. Program access1
4. Housing3
5. Government benefits/services3
6. Transportation1
7. Education8
8. Assistive technology0
9. Voting0
10. Health care19
11. Insurance0
12. Non-government services2
13. Privacy rights1
14. Access to records0
15. Abuse3
16. Neglect16
17. Other1

D. Reasons for Closing Individual Case Files

1. Issues resolved partially or completely in individual favor19
2. Other representation found2
3. Individual withdrew complaint5
4. Appeals unsuccessful0
5. PAIR Services not needed due to individual's death, relocation etc.3
6. PAIR withdrew from case3
7. PAIR unable to take case because of lack of resources0
8. Individual case lacks legal merit4
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-advocacy2
2. Short-term assistance19
3. Investigation/monitoring5
4. Negotiation2
5. Mediation/alternative dispute resolution3
6. Administrative hearings1
7. Litigation (including class actions)2
8. Systemic/policy activities2

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 - 2210
3. 23 - 5928
4. 60 - 647
5. 65 and over15

B. Gender of Individuals Served

Multiple responses not permitted.

1. Females26
2. Males34

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 Native0
3. Asian0
4. Black or African American11
5. Native Hawaiian or Other Pacific Islander0
6. White35
7. Two or more races2
8. Race/ethnicity unknown10

D. Living Arrangements of Individuals Served

Multiple responses not permitted.

1. Independent8
2. Parental or other family home12
3. Community residential home2
4. Foster care0
5. Nursing home27
6. Public institutional living arrangement3
7. Private institutional living arrangement1
8. Jail/prison/detention center5
9. Homeless0
10. Other living arrangements2
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-blind2
4. Orthopedic impairment16
5. Mental illness0
6. Substance abuse0
7. Mental retardation0
8. Learning disability4
9. Neurological impairment7
10. Respiratory impairment3
11. Heart/other circulatory impairment6
12. Muscular/skeletal impairment4
13. Speech impairment0
14. AIDS/HIV2
15. Traumatic brain injury0
16. Other disability15

Part IV. Systemic Activities and Litigation

A. Systemic Activities

1. Number of policies/practices changed as a result of non-litigation systemic activities4

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.

Statewide Transition Plan - Kentucky P&A has been tracking and commenting on our state’s response to the HCBS Federal Final Rule. Kentucky P&A filed comments in previous years and this year repeated the concern that the Final Rule will not directly affect day services. Kentucky P&A said that waiver day services have the potential to be just as isolating as residential settings. The Center for Medicare and Medicaid Services gave its final approval of Kentucky’s Statewide Transition Plan in June of 2017. Response to RFI regarding HCB Waivers - The Centers for Medicare and Medicaid Services asked for a response to its Request for Information on Home and Community Based Waivers. Kentucky P&A responded and said, among other things, that CMS should look at the impact enrollment caps have on Olmstead compliance and that CMS should require states to include participant directed employee start-up costs as part of an administrative cost or allow recipients the option of including employee start-up costs as a budget item. DPA’s comments on the 1115- Kentucky P&A helped the Kentucky’s Department of Public Advocacy (DPA) analyze and draft comments on Kentucky’s proposed 1115 waiver. DPA noted that Kentucky joined the 30 other states that suspend Medicaid rather than terminate it when a recipient is incarcerated. DPA asked that those individuals that are suspended be exempt from paying premiums and the community engagement requirements. Kentucky P&A’s comments on the revised 1115- Kentucky P&A filed comments on Kentucky has Revised 1115 Waiver proposal. Kentucky P&A previously commented on the original 1115 Waiver draft in July of 2016. The comments to the Revised 1115 noted that the Cabinet clarified that traditional Medicaid recipients and 1915(c) Waiver recipients are not included in the 1115. Additionally, individuals eligible for SSDI are automatically determined to be medically frail. Kentucky P&A also noted that the revised 1115 could negatively affect those with mental illness as they could be disenrolled from Medicaid for non-compliance with co-pays and the community engagement requirement. 501 KAR 6:11:0 Roederer Correctional Complex- Kentucky P&A provided comments about the increase in time an inmate spends in holding cells during classification and advocate for decreased time in special management units, especially for inmates with disabilities. 922 KAR 5:120 Caregiver misconduct registry and appeals-Kentucky P&A provided comments regarding the ability of the Cabinet to amend, modify or reverse an investigative finding without any standard for such change. Patient Liability- During 2016-2017 Kentucky P&A continued to assist individuals who had questions about paying a patient liability for Medicaid Waiver services. In 2011, KY P&A’s work led to positive changes in the way Kentucky charged patient liability. Prior to this change in policy, many Medicaid Waiver recipients unnecessarily had to pay hundreds of dollars each month to access services. Since 2011, Kentucky P&A has helped scores of recipients address the patient liability issue. Project Safe- 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. Long Term Care Nursing Facilities- Kentucky P&A met with each ombudsman of the 15 districts to discuss available resources to transition a person into the community, Kentucky P&A’s services, areas of concern and how Kentucky P&A could collaborate with the Long Term Care Ombudsman program. The priority increased Kentucky P&A’s visibility in nursing facilities and enhanced a working relationship with the Long Term Care Ombudsman program. A number of nursing facilities and nursing facility residents have contacted Kentucky P&A for technical assistance to provide direct services that have included help with transitioning to the community, help to secure PASRR II services and help with obtaining assistive technology. Resources for parents of children with learning disabilities- Kentucky P&A reviewed the current resources available throughout the state for parents regarding educational advocacy, vocational counseling, and services and other services for transitioning students, and sent a survey to the Directors of Special Education in each district. SB 200- Kentucky P&A provided federal data to stakeholders that showed children with disabilities disproportionately represent the population of children involved in Kentucky’s juvenile justice system. Kentucky P&A provided training to the court designated workers about community services and supports for children with disabilities. Kentucky’s court designated workers referred clients to Kentucky’s P&A for assistance after receiving the training Reentry 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. Restrictive Housing Units in state prisons-Kentucky Protection and Advocacy (P&A) summarized information gathered during the FY 2016 monitoring of 13 state prisons in Kentucky. The focus of the monitoring effort was on restrictive housing units or “23 hours a day in a cell” and inmates who have a mental health diagnosis who reside in these units. . Kentucky P&A gathered about an inmate’s disability to determine if the inmate received medication for the disability. Kentucky P&A drafted a formal letter to the Warden of each prison explaining our specific concerns and recommendations. Monitored Jails- Kentucky P&A drafted a monitoring tool for jails and completed monitoring in four jail in the Western, Eastern, Central and Northeast part of the state. Kentucky P&A developed a relationship with the local facilities coordinators at the Kentucky Department of Corrections. At each jail, Kentucky P&A collected disability statistics, toured the facility and interviewed leadership staff and mental health treatment staff. Kentucky P&A also requested and reviewed jail policies. Advocacy for inmates with disabilities in jails resulted in some positive systemic changes including revision of individual jail policies, increased attention by DOC on jail operations and awareness of P&A services and supports for inmates with disabilities. Kentucky Correctional Psychiatric Center-Kentucky P&A monitored the Kentucky Correctional Psychiatric Center (KCPC). KCPC, Kentucky’s fifth public psychiatric hospital, is a secure facility operated by the Kentucky Department for Behavioral Health, Developmental and Intellectual Disabilities (DBHDID), where pre-trial evaluations are conducted to determine if a patient is competent stand trial. Through monitoring KYPA was able to determine the patients at KCPC were receiving appropriate services and having their rights upheld. Legislation that affects all PAIR eligible clients-Kentucky P&A monitors all legislation that affects PAIR eligible clients during the legislative session and when Federal legislation is filed that affects PAIR eligible clients. The Kentucky P&A’s webpage is updated daily during the legislative session. Collaboration with the Kentucky Commission for the Deaf and Hard of Hearing and Department of Behavioral Health-Kentucky P&A and the Kentucky Commission for the Deaf and Hard of Hearing and the Department of Behavioral Health began discussions regarding access to legal advocacy services for the DHH community through Kentucky P&A. The group developed a collaborative effort to increase the knowledge and awareness within the DHH community of Kentucky P&A’s services. This collaborative effort is designed to eliminate barriers, share resources, and increase the understanding of and access to Kentucky P&A services.

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.

1. Abuse, Neglect, and Exploitation Kentucky P&A will investigate allegations of abuse and neglect, including allegations of restraint/seclusion in institutional and community based programs providing services to PAIR eligible clients. Individual Advocacy 1.1Kentucky P&A will investigate all *suspicious deaths. IAN will review all reports of suspicious deaths made to or that P&A becomes aware via monitoring efforts, media reports or notices sent to Kentucky P&A. Kentucky P&A Internal Abuse and Neglect Team (IAN) received notifications of notices five deaths of PAIR eligible clients. Not all of the deaths met the criteria of IAN’s protocol, which states the abuse or neglect cause serious injury or death. Some of the individuals died of natural causes or had terminal illnesses. The IAN Team conducted two death investigations of PAIR eligible clients. Case Summary DM was an 88-year old woman with an orthopedic disability. She lived in a nursing facility in rural Kentucky. DM died after she sustained a closed head injury 10 days prior to her death. Advocate requested medical records and Office of Inspector General records that included a Plan of Correction due to a Type A citation by the OIG. The review revealed another incident where the resident fell from her chair six weeks prior to her death. According to the citation, her Plan of Care was revised at that time to address her falling out of her wheelchair with new interventions. The citation revealed that staff were never in-serviced on this plan; therefore, changes were not implemented. The facility was placed on immediate jeopardy by the OIG. The facility submitted an acceptable Plan of Correction that was accepted by the OIG. DM did not have a legal guardian, but did have a son as next of kin. Kentucky P&A contacted the son to ensure he was aware of the citations and notified him of his right to consult a private attorney. Son did hire a private attorney and indicated the Health and Human Services Head Prosecutor fined the facility over $400,000 for this event and other related incidents. Last contact with son was that he was starting mediation against the facility. 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 and community programs providing services to PAIR eligible clients. The IAN team will review all reports made to Kentucky P&A or made by other entities, including media outlets, and monitoring efforts. Kentucky P&A’s Internal Abuse and Neglect (IAN) Team received 33 notifications of abuse and neglect of PAIR eligible clients. Not all of the notifications met IAN’s protocol to open an investigation, which states the abuse or neglect must result in serious injury or death. The IAN Team investigated four of abuse and neglect for PAIR eligible clients, including the two death investigations. Case Summary: Kentucky P&A received notification of a Type-A Citation issued by the Office of Inspector General (OIG) to Woodcrest Nursing and Rehabilitation Center in Elsmere, Kentucky following the death of 45-year-old RC. The IAN team agreed to open a secondary investigation. RC was an individual who was diagnosed with Muscular Dystrophy, Depression, COPD, Congenital Myopathies, Acute & Chronic Respiratory Failure, Hypokalemia, Generalized Anxiety Disorder, Vitamin D Deficiency, Hypertension, Muscle Weakness, and Feeding Difficulties. RC was found deceased at the facility on 3/20/16 due to a fall down a flight of stairs in his electric wheelchair. A review of the autopsy report shows that RC's death was ruled accidental. The Type-A and OIG investigation found that the nursing facility was in violation of several regulations due to not knowing RC’s whereabouts for several hours and not following protocol in locating residents that are considered as eloped. The nursing investigation concluded that it was suspected that RC committed suicide; however, he had no prior demonstrations of suicidal ideations. The Department of Community Based Services (DCBS) conducted an investigation and substantiated caretaker neglect against three employees. Criminal charges were considered also by law enforcement. RC was his own person, but his family was notified during the incident because one nurse stated that RC was with his family during the time that he could not be found, which was found to be false. Based on the information reviewed, it appears that all parties properly conducted appropriate investigations. The facility was cited by the OIG and DCBS substantiated the allegations 1.3 Kentucky P&A Internal Abuse and Neglect (IAN) Team will review Type A/B Citations issued by the Office of Inspector General incident reports, and other notices of alleged abuse/neglect/exploitation to determine further action, including conducting primary or secondary investigations. Kentucky P&A IAN Team reviewed 33 Type A/B Citations issued by the Office of Inspector General, incident reports, and other notices of alleged abuse/neglect/exploitation to determine further action for PAIR eligible clients residing in long-term care facilities. Systemic Advocacy 1.4 Kentucky P&A will attend meetings and participate in Project SAFE’s (Safety & Accessibility for Everyone) planning/educational/outreach efforts, implementation of the strategic plan, including the Crisis Intervention Training (CIT) with the Louisville Metro Police and the statewide 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. Kentucky 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. Kentucky P&A worked with Project SAFE Executive Committee members on the 5th Annual statewide Advocating to End Abuse Against People with Disabilities Summit, which will be held in Frankfort in FY’18. The focus is healthy relationships and people with disabilities. Kentucky P&A had an informational table at the Kentucky Attorney General’s Victim Assistance Conference, 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 eight trainings and provided feedback to 203 officers, participated in quarterly meetings of CIT Advisory Board for Louisville Metro Police Department. Kentucky’s P&A advocate representative on Project SAFE was nominated by the KY Attorney General’s Office to be a “Subject Matter Expert” to review Victim of Crime Act grant applications. Ten applications for programs throughout the Commonwealth were assigned to the advocate who reviewed them and made recommendations regarding service to individuals with disabilities. Kentucky P&A was also appointed to the Advisory Committee for the Kentucky Victim’s Assistance Academy, which will be held in FY’18. 2. Olmstead Kentucky P&A will represent persons institutionalized or at risk of institutionalization to ensure they have access to services and supports in the most integrated living arrangement. Individual Advocacy 2.1 Kentucky P&A will represent or provide TA to parent/guardian of children and 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 represented and/or provided technical assistance one PAIR eligible adults living in nursing facilities seeking to receive services and supports in a more integrated living arrangement. Case Summary NG is an African American male, age 53. He had a stroke that caused orthopedic and brain impairment. He received the Home and Community Based Waiver (HCB) and was told about the Acquire Brain Injury Waiver (ABI). At that time, in order to apply for ABI through the Medicaid Waiver Management Application, (MWMA) (an automated online application system) a person could not be on a waiver and apply for another waiver. He voluntary gave up HCB to apply for ABI. Medicaid sent him back to HCB without due process notices for ABI. In the meantime, he lost his Medicaid because he lost his waiver. SSI declared NG disabled. He tried to regain Medicaid, but Medicaid told him there was a problem with his paperwork. He called repeatedly to the Medicaid help desk without success. He lost his therapies and was losing the abilities therapy was helping him gain. One of the therapies was regaining the ability to walk. He had a setback.After several contacts with Medicaid and the Cabinet for Health and Family Services (CHFS) Ombudsman, it was discovered that a computer glitch caused him to lose his Medicaid and find him ineligible. The help desk could not solve the problem. It had to be taken to senior Medicaid officials. Working with Medicaid, the CHFS Ombudsman and the ABI case manager, he was approved for Medicaid. NG’s case had to be reviewed by a disability/Medicaid review committee. After Medicaid approval, NG was approved for ABI. 2.2 Kentucky P&A will represent adults with disabilities at risk of institutionalization and in need of community services and supports under Olmstead, who do not meeting the above individual advocacy priorities. Kentucky P&A represented four seven PAIR eligible adults at risk of institutionalization and in need of community services and supports. Case Summary: Kentucky P&A met MC, a 56-year-old male with a disability during a nursing home monitoring visit. Nursing facility staff discussed MC returning to the community with supports and services. MC broke his neck at age 19, which resulted in no paralysis but the inability to walk. He entered nursing facility in fall 2014 because of skin infections. Kentucky P&A also provided assistance with patient liability and two notices from nursing facility to discharge because of payment disputes. These issues were resolved. Several issues arose while applying for Kentucky Transitions (Money Follows the Person). When MC entered nursing facility, he did not apply for Medicaid. The facility social worker helped MC apply and he was approved for Medicaid. When he entered the facility, he entered as a rehabilitation patient and was not eligible for Kentucky Transitions. Later he moved into long-term care. The first time he applied to Kentucky Transitions, his paperwork was lost. The second time, Kentucky Transitions decided he was not eligible for services. After making a records request, it was determined the medical report was made in error. The social worker for facility acknowledged a mistake had been and said she would resubmit the Kentucky Transitions pre-application. However, after several follow-ups with her, she had not sent the required paperwork to Kentucky Transitions. Pre-applications must be generated from facility not resident of nursing facility. A resident can call Kentucky Transitions but the nursing must submit diagnosis. Kentucky P&A spoke with Kentucky Transition and they agreed to have a Kentucky Transitions staff complete the application when they were in facility. During the assessment, it was determined that MC had lost body strength since being in the facility and could no longer left himself to transfer from bed to power wheelchair, wheelchair to bed. It was possible with physical rehabilitation client could regain strength. MC made the decision not return to the community at this time. Systemic Advocacy 2.3 Kentucky P&A will analyze data collected from 100 nursing facility visits during FY 2015 and FY 2016. Kentucky 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. Kentucky P&A will also meet with Volunteer Ombudsmen. Curing fiscal year 2017, Kentucky P&A completed the nursing home priority. The priority was two-fold. The first part of the priority was to analyze data collected from 100 nursing facility visits during 2015 and 2016. Staff conducted onsite monitoring in nursing facilities throughout the Commonwealth. Monitoring sites were chosen from comprehensive mental health regions, from Office of Inspector General (OIG) surveys where Types A and B citations were issued, and from facilities where Kentucky P&A had received Information & Referral calls. Kentucky P&A analyzed data taken from survey tools used at nursing facilities to gather information. Nursing home administrators, directors of nursing and directors of social work were nursing home personnel used to complete the survey tool. A sample of the questions on the tool asked for census numbers, characteristics of the particular nursing facility population, PASRR assessments, PASRR II services and transitioning to the community through KY Transitions, Money Follows the Person and Community Mental Health Center Assertive Community Treatment (ACT) teams. The data indicated that most facilities had individuals under the age of 64 with intellectual, developmental, mental health and traumatic brain injury disabilities. Not all individuals with intellectual and developmental disabilities were receiving PASRR II services, but many were. Many nursing facility were not well information about PASRR II specialized services or KY Transitions, Money Follows the Person. The second part of the priority consisted of meeting with the Long Term Care Ombudsman. Kentucky P&A meet with each ombudsman of the 15 districts to discuss available resources to transition a person into the community, Kentucky P&A’s services, areas of concern and how Kentucky P&A could collaborate with the Long Term Care Ombudsman program. The priority increased Kentucky P&A’s visibility in nursing facilities and enhanced a working relationship with the Long Term Care Ombudsman program. A number of nursing facilities and nursing facility residents have contacted Kentucky P&A for technical assistance to provide direct services that have included help with transitioning to the community, help to secure PASRR II services and help with obtaining assistive technology. 3. Education PAIR eligible children/youth will be provided a free and appropriate education (FAPE). Individual Advocacy 3.1 Kentucky P&A will represent at least one 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 two PAIR eligible children and youth in public schools who had inappropriate IEPs and were placed in an inappropriate educational setting. Case summary: TG is a 13yr. old who is diagnosed with ADHD. He was expelled from Lawrence County schools after another student reported that he was trying to start a fire in the school bathroom. The school filed felony charges against TG that were later amended. The school did provide homebound instruction, but refused to let TG return. Kentucky P&A advocate assisted TG’s grandmother (his guardian) with drafting an appeals letter to the school board. The school board met and agreed TG could return to school following winter break, but would have to attend the alternative school for the remainder of the year and for his 8th grade year. If he has no further incidents and maintains a 3-point GPA, he can return to the high school once he enters 9th grade. TG made the transition to the alternative school and had no further incidents. 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 two PAIR eligible children and youth to determine if there was a violation of the child/youth’s educational rights under state and/or federal law. Case Summary: BN is a 12-year-old sixth grader at Owensboro Middle School in the Daviess County Public School system. She has diagnoses of ADHD, ODD, anxiety, depression, and a learning disability. BN had an IEP, but the ARC took BN off the IEP after she had her 3-year re-evaluation. Instead, BN was given a 504 plan. The parents did not agree with this and requested mediation. An independent evaluator reevaluated BN and a mediation was held. However, during mediation, an agreement could not be reached. Parents wanted Kentucky P&A to represent BN at a due process hearing. However, the parents were informed Kentucky P&A could not represent BN at the due with out first reviewing records. Kentucky P&A attorney advised parents that a case could be opened to review the records and the parents agreed. It was discovered that BN received many of the same accommodations on her IEP and on her 504 plan. BN has a 71 IQ. Kentucky P&A attorney discussed with parent about what the issues. BN’s parents were concerned about the implementation of the 504 plan and about BN's executive functioning concerns. Kentucky P&A attorney advised BN’s parents about what they needed to do to ensure that the 504 was being implemented correctly and arranged for a family peer specialist to attend the ARCs. The case was closed because Kentucky P&A could not find a legal rights violation. BN’s parents better understood what the laws were concerning special education after speaking with Kentucky P&A attorney. BN’s parents better understood what they needed to do to ensure that the 504 was being implemented correctly and learned what legal options they had if the 504 was not followed. 3.3 Kentucky P&A will provide technical assistance to parents/guardians/caseworkers of children and youth with disabilities regarding addressing violations of the child’s educational rights. Kentucky P&A provided technical assistance to parents/guardians/caseworkers of two PAIR eligible children and youth regarding violations of the child/youth’s educational rights. Case Summary SH is an 8-year-old white male who resides in Jefferson County who has a visual impairment. He attends a private school, but his mother wanted to know if he could obtain vision services through the public school system. Kentucky P&A attorney researched vision therapy and services SH could receive through the public schools. Kentucky P&A attorney discussed findings with SH’s mother. Systemic Advocacy 3.4 Kentucky P&A, along with The Arc of Kentucky and KYSPIN, will provide trainings to parents/grandparents/foster parents on Special Education and related topics across Kentucky. Kentucky P&A assisted with training and provided publications explaining the special education process to Kentucky’s Parent-Training Information Center, Special Parent Involvement Network (SPIN) and to the ARC of Kentucky to parents, grandparents, and foster parents in Frankfort, Louisville, Lexington, and Paducah. Each participant received Kentucky P&A’s special education publications. 3.5 Kentucky P&A will identify resources available throughout Kentucky 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 advocate for the educational rights of their children. Kentucky P&A reviewed the current resources available throughout the state for parents regarding educational advocacy, vocational counseling, and services and other services for transitioning students, and sent a survey to the Directors of Special Education in each district. Respondents support providing parents/guardians with guidance on educational advocacy, however, there was not consistency in the resources provided to parents across districts or in the manner in which resources were provided. While some districts refer parents to the Kentucky Disabilities Resource Manual or the Kentucky Department of Education website, many respondents reported depending on the Procedural Safeguards provided to parents/guardians during ARC meetings as their sole source of resources provided to parents. Kentucky P&A identified multiple educational advocacy resources that are available for parents/guardians. The Kentucky Interagency Transition Council, KY Spin, and eight special education cooperatives, which service every school district in Kentucky, provide vital resources to parents/guardians. Kentucky P&A did not find any data to measure the effectiveness of these resources in getting needed information or assistance to parents/guardians. Anecdotal evidence suggests parents/guardians are not accessing needed information and that innovative and collaborative inter-agency efforts needed to increase parent/guardian access to resources. Kentucky P&A spent last year working to identify information and resources available to parents and to identify gaps in information and services relating to educational advocacy. Kentucky P&A is currently working to strategize ways to increase comprehensive access to information and resources for parents/guardians across the state. 3.6 Kentucky P&A will present and/or post online training regarding special education services for children with Specific Learning Disabilities. Kentucky P&A posted an online training regarding children diagnosed with learning disabilities and the IEP process. Due to Kentucky’s model of evaluation for Specific Learning Disabilities (the “discrepancy model”), many youth with a diagnosis of SLD experience difficulties in education but do not qualify for special education services. 4. Health Care PAIMI eligible clients will have the right to access health care, including physical and behavioral services. Individual Advocacy 4.1 Kentucky P&A will represent Medicaid eligible adults who are denied medical, dental, and other health services or whose services are reduced or terminated. Kentucky P&A represented four PAIR eligible adults whose healthcare services were denied or they were not able to access healthcare. Case Summary: HJ, a 93 year old female, contacted Kentucky P&A for assistance obtaining recertification for the Home and Community Based Waiver, Participant Directed Services (HCB PDS) and recertification for Medicaid. HJ remained in the community with supports and services provided under HCB. Without HCB, HJ would be institutionalized. HJ had been a HCB PDS recipient for about 7 years. Kentucky began using an automated system to process the recertifications, but due to software/computer issues, her information could not be placed in the automated system. After consulting with Medicaid and case managers, Kentucky P&A discovered that Medicaid, for the last several years, had authorized waiver service and Medicaid outside the automated system and that caused the automated system to reject all attempts to input information. Both Medicaid issues were resolved by contacting two different Medicaid divisions. 4.2 Kentucky P&A will represent 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. Kentucky P&A represented one PAIR eligible child to ensure they were discharged with appropriate plans. Case Summary JH is a 13-year-old male who has speech and developmental delays. He attends school in a rural school district and does not have an Individual Education Plan or a 504 Plan. JH’s legal guardian contacted Kentucky P&A to assist with ensuring JH received educational accommodations due to his disability. Kentucky P&A attorney attended meetings at JH’s school. An IEP and 504 Plan was developed to accommodate JH’s disabilities. 5. Criminal Justice The rights of PAIR eligible clients in the criminal justice system Individual Advocacy 5.1 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 provided technical assistance to the Department of Public Advocacy (DPA) attorneys representing two adults with disabilities who interface with the criminal justice system. Case Summary A public defender contacted Kentucky P&A because the physician at the jail was removing seizure medications from several of her clients and instead was prescribing Tic Tacs at a rural county jail. He continued to prescribe Tic Tacs for intestinal complaints for the inmates. One inmate complained of stomach issues, was taken to the hospital for gallbladder concerns. The emergency room wrote prescriptions for treatment, however since the prescriptions were not ordered by the jail's medical authority, the inmate would have to wait for the medical authority to write a prescriptions. This information was relayed to a Kentucky P&A attorney who contacted the Kentucky Department of Corrections. The public defender wanted Kentucky P&A's assistance because she practiced this small community and was fearful if she complained about the jail, the inmates might suffer retaliation. Kentucky P&A contacted the Kentucky Department of Corrections facilities manager who did verify the jail did prescribe Tic Tacs to the female inmate who was complaining of stomach pain. This was prior to being transported to the hospital. Kentucky P&A wrote a letter to the jailer citing KRS 44.045, 502 KAR 3:090, the provision to provide medical care to inmates in custody. In addition, information about prescribing alternative therapies was included from the Kentucky Medical Licensure Board. 5.2 Kentucky P&A will monitor the cases of children/youth with disabilities impacted by SB 200. Kentucky Kentucky P&A represented one PAIR eligible youth impacted by SB200. Case Summary: MB is a 14 year old with speech and developmental delays. She attends school in the Martin County School District, but does not Individual Education Plan or a 504 Plan. The school filed terroristic threatening charges against MB for writing on a wall that a bomb was going to go off in the school at 3 pm. MB’s legal guardian and grandmother advised Kentucky P&A that MB’s mother used illegal drugs while pregnant with MB. MB’s court-designated worker (CDW) contacted Kentucky P&A. Kentucky P&A advised the CDW about special education laws. With the encouragement of the CDW, MB’s legal guardian contacted Kentucky P&A. Kentucky P&A informed the legal guardian about the special education laws relate to the criminal justice system. Kentucky P&A also informed the legal guardian on how Kentucky was attempting to reform its juvenile justice system. The legal guardian was interested in Kentucky P&A opening a case for Kentucky P&A to monitor the criminal justice reforms. Kentucky P&A’s involvement assisted MB’s family to understand the way that the criminal justice system interacts with the school system and MB’s legal guardian and court-designated worker were better able to advocate for MB. This allowed MB with a better opportunity in receiving needed services, so that she could stay out of the criminal justice system. Systemic Advocacy 5.3 Kentucky P&A will monitor the implementation of SB 200, juvenile justice reform. Kentucky P&A provided federal data to stakeholders that showed children with disabilities disproportionately represent the population of children involved in Kentucky’s juvenile justice system. Kentucky P&A provided training to the court designated workers about community services and supports for children with disabilities. Kentucky’s court designated workers referred clients to Kentucky’s P&A for assistance after receiving the training. 5.4 Kentucky P&A will collaborate with the Kentucky Department of Corrections to update the Resource Reentry 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 summarize the information gathered during the FY 2016 monitoring of mental health units and restrictive housing units in the 13 prisons in Kentucky. Kentucky Protection and Advocacy (P&A) summarized information gathered during the FY 2016 monitoring of 13 state prisons in Kentucky. The focus of the monitoring effort was on restrictive housing units or “23 hours a day in a cell” and inmates who have a mental health diagnosis who reside in these units. . Kentucky P&A gathered about an inmate’s disability to determine if the inmate received medication for the disability. Kentucky P&A drafted a formal letter to the Warden of each prison explaining our specific concerns and recommendations. In addition, Kentucky P&A has reviewed regulatory changes made by the Kentucky Department of Corrections (DOC) and by each individual prison. Kentucky P&A comments on policy amendments, which were relevant to our advocacy efforts for inmates with disabilities including the mental health policy, the special management policies and other disability related policy amendments. Kentucky P&A reviewed the records of individual inmates who had a disability and were in segregation or had other disability related concerns. Twenty-four total records reviews since the completion of monitoring were considered for systemic advocacy purposes. Kentucky P&A advocated for each inmate. Many inmates were removed from segregation or received more treatment and services. Kentucky P&A represented and reviewed records for two inmates who were held in four point restraints for more than thirty days, and for another inmate who was in segregation for an extended period. Kentucky P&A requested that an expert review and provide recommendations to DOC. The expert was provided with records and went to complete a full tour including a client meeting for each inmate. The completed expert report was sent to the DOC Commissioner and meetings will be scheduled to discuss in the next priority year. Kentucky P&A referred all of these inmates to private counsel and provided technical assistance to one of those attorneys. Kentucky P&A researched and drafted a legal memo to determine whether segregation of inmates with disabilities for twenty-three hours per day was cruel and unusual punishment under the eighth amendment to the Constitution. 5.6 Kentucky P&A will monitor county jails. Kentucky P&A drafted a monitoring tool for jails and completed monitoring in four jail in the Western, Eastern, Central and Northeast part of the state. Kentucky P&A developed a relationship with the local facilities coordinators at the Kentucky Department of Corrections. At each jail, Kentucky P&A collected disability statistics, toured the facility and interviewed leadership staff and mental health treatment staff. Kentucky P&A also requested and reviewed jail policies. Advocacy for inmates with disabilities in jails resulted in some positive systemic changes including revision of individual jail policies, increased attention by DOC on jail operations and awareness of P&A services and supports for inmates with disabilities. 5.7 Kentucky P&A will monitor the Kentucky Correctional Psychiatric Complex. Kentucky Protection and Advocacy monitored the Kentucky Correctional Psychiatric Center (KCPC). KCPC, Kentucky’s fifth public psychiatric hospital, is a secure facility operated by the Kentucky Department for Behavioral Health, Developmental and Intellectual Disabilities (DBHDID), where pre-trial evaluations are conducted to determine if a patient is competent stand trial. The facility also provides treatment for individuals serving felony sentences. The methods used to monitor included interviewing staff, interviewing patients, touring the facility, and reviewing policies and procedures. The facility provides services to both men and women from across the state. The average length of hospitalization at KCPC is three weeks, but can be extended if ordered by a judge. Every patient at KCPC has legal representation before admitted to the facility. There are three residential units at KCPC capable of holding 24 patients per unit. One-half of a unit is reserved for female patients. There is no mental health unit, but there is one isolation cell per unit. The facility employs 10 full-time and five part-time licensed mental health staff. In addition, there are social workers, nurses, doctors, recreation staff, and security staff employed by the facility. All staff are trained how to interact with patients who have disabilities, especially those with serious mental illness. All patients must have a treatment plan and a doctor must approve any changes to the plan. The facility views as a psychiatric hospital and refers to the individuals as “patients” not “inmates.” Through monitoring KYPA was able to determine the patients at KCPC were receiving appropriate services and having their rights upheld. 6. Protect, Promote and Exercise Rights Persons with disabilities will have access to goods/services/programs Individual Advocacy 6.1 Kentucky P&A will represent 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. Kentucky P&A represented four PAIR eligible adults and children who were discriminated against due to disability. Case Summary: NR, an African American female, age 35, sought a reasonable accommodation for course work in her Master’s program at a religious institution of higher education. It was determined that the university received federal funding and thus fell under the provisions of the ADA and Section 504. In 2012, NR began course work and her practicum at university. The university and the local public school district had a memorandum of understanding for social worker practicum. NR worked under a licensed therapist of the university at the local school district. NR was assigned to a middle school and she conducted group counseling. Students in her group began fighting. NR was seriously injured when she broke up the fight. She was hospitalized and surgery was required to repair internal injuries. Unfortunately, the surgeon perforated her colon. This ultimately led to sections of intestines and colon being removed. She has an ostomy and orthopedic impairments. NR took two different medical leaves of absences from school. In 2017, the university and Jones arranged for her to complete all course work and complete practicums. The University gave her until December to complete 175 hours and to obtain 300 relational points. NR believed she would be able to complete work; however, health complications caused her to be absent. In spring 2017, the university raised concerns about her health and her ability to complete the program. NR was aware that she could file complaints and pursue a lawsuit. She wanted to graduate and wanted Kentucky P&A help to obtain a reasonable accommodation to complete course work. P&A agreed to help facilitate this situation through letters and meetings. While Kentucky P&A was representing NR, the university involuntarily withdrew client because of medical reasons. NR had been hospitalized three times and had two surgeries, missing classes and practicums during the semester. The dean of students, and program head spoke with P&A attorney by conference call. The dean said the university would not provide a reasonable accommodation. The university believed they had provided an accommodation because the university let her return to school and developed a plan with her to complete degree. NR decided she would withdrew because of health reasons. Systemic Advocacy 6.2 Kentucky P&A will meet with Long-Term Care Ombudsmen and the Inspector General to raise awareness about the lack of accessibility of the posting of the Long-term Care Rights Poster in long-term care facilities. This will include ensuring posters are placed in areas of the facility where residents can easily access the poster, creating a poster that is updated and uses large font. This also includes ensuring residents who do not leave their rooms have an accessible copy. Kentucky P&A met with each of the Long Term Care Ombudsmen to discuss posting long-term care rights in areas of long-term care facilities so individuals can easily access the information. During monitoring visits to long-term facilities, Kentucky P&A has observed information about resident rights is often not accessible. The Long Term Care Ombudsmen agreed this is a problem and will work with long term care facilities to present information in an accessible manner. 6.3 Kentucky P&A will update the webpage daily during the legislative session regarding legislation that may or will affect individuals with disabilities. Kentucky P&A monitors all legislation that affects PAIR eligible clients during the legislative session and when Federal legislation is filed that affects PAIR eligible clients. The Kentucky P&A’s webpage is updated daily during the legislative session. Objective: Met 7. Outreach Outreach to underserved areas that provide services to PAIMI eligible clients Individual Advocacy 7.1 Kentucky P&A will represent individuals from underserved disability, minority, or geographic groups/populations. Kentucky P&A represented three PAIR eligible adults and children from underserved disability, minority, or geographic groups/populations. Case Summary: NG is an African American male, age 53. He had a stroke that caused orthopedic and brain impairment. He received the Home and Community Based Waiver (HCB) and was informed about the Acquire Brain Injury Waiver (ABI). At that time, in order to apply for ABI through the Medicaid Waiver Management Application, (MWMA) (an automated online application system) a person could not be on a waiver and apply for another waiver. He voluntary gave up HCB to apply for ABI. Medicaid sent him back to HCB without due process notices for ABI. In the meantime, he lost his Medicaid because he lost his waiver. SSI declared NG disabled. He tried to regain Medicaid, but Medicaid told him there was a problem with his paperwork. He called repeatedly to the Medicaid help desk without success. He lost his therapies and was losing the abilities therapy was helping him gain. One of the therapies was regaining the ability to walk. He had a setback. Kentucky P&A contacted Medicaid and the Cabinet for Health and Family Services (CHFS) Ombudsman and it was discovered that a computer glitch caused him to lose his Medicaid and find him ineligible. The help desk could not solve the problem. It had to be taken to senior Medicaid officials. Kentucky P&A worked with Medicaid, the CHFS Ombudsman and the ABI case manager and eventually NG was approved for Medicaid. NG’s case had to be reviewed by a disability/Medicaid review committee. After Medicaid approval, NG was approved for ABI. Systemic Advocacy 7.2 Kentucky P&A and the PAIMI Advisory Council will participate in fundraising efforts to support Relay for Life and will participate in the annual Relay for Life Event in Frankfort, KY. Outcome: Kentucky P&A and the PAIMI Advisory Council participated in monthly fundraising efforts to support Relay for Life and participated in the annual Relay for Life event in Franklin County, Kentucky. 7.3 Kentucky P&A will participate in two non-disability related outreach events Outcome: Kentucky P&A participated in two non-disability related events, providing information about Kentucky P&A and mental health rights and services in the state at the Attorney General’s Victim Advocacy Conference and in the annual Relay for Life Event. 7.4 Kentucky P&A will continue to have a disability rights advocate stationed in the Department for Public Advocacy field office in Prestonsburg, an underserved geographical area. Since November 2012, Kentucky P&A has had a disability rights advocate at the DPA office located in Prestonsburg, however in 2017, the disability rights advocate sought other employment and is no longer an employee of Kentucky P&A. This initiative was effective increasing the visibility of and number of individuals served by P&A in the eastern part of the state, an underserved geographic population. 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. 7.5 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 to create an informative video presentation in American Sign Language to inform the deaf and hard of hearing community of services available through Kentucky P&A and to identify opportunities for collaboration and sharing of resources. Last year, Kentucky P&A and the Kentucky Commission for the Deaf and Hard of Hearing and the Department of Behavioral Health began discussions regarding access to legal advocacy services for the DHH community through Kentucky P&A. The group developed a collaborative effort to increase the knowledge and awareness within the DHH community of Kentucky P&A’s services. In addition to training staff on Kentucky P&A’s mission, services, and intake process, Kentucky P&A has worked with these agencies to create a series of informative videos (that are both video captioned and have ASL translation) to increase awareness of Kentucky P&A within the DHH community and increase Kentucky P&A’s capacity to serve this population. To date, video presentations include An Introduction to Kentucky P&A, Education (including youth transitioning to adulthood), and Advocating for Youth, and Senior Care Facilities. Staff from the three agencies communicate on a regular basis to share scenarios and legal remedies that may affect the DHH community. This collaborative effort is designed to eliminate barriers, share resources, and increase the understanding of and access to Kentucky P&A services.

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.

Priorities and Objectives for Current Fiscal Year 2018 I. Abuse, Neglect, and Exploitation Kentucky P&A will investigate allegations of abuse and neglect, including allegations of restraint/seclusion in institutional and community based programs providing services to PAIMI eligible clients. Individual Advocacy 1.1 Kentucky P&A will investigate all *suspicious deaths. The Internal Abuse and Neglect (IAN) Team will review all reports of suspicious deaths reported to Kentucky P&A or that Kentucky P&A becomes aware via The Office of Inspector General, media outlets, monitoring efforts, etc. 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. 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 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. 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 statewide CIT program. 1.5 Kentucky P&A will request and review quarterly all PRTF serious occurrence reports. Kentucky P&A will compare reports provided with OIG facility surveys and follow-up all failures to report with the facility and/or CMS. 1.6 Kentucky P&A will monitor ALL service providers to children and/or adults with disabilities in Anderson, Franklin, Owen, Scott and Woodford counties. 1.7 Kentucky P&A will review DCBS policy/regulation regarding investigation of allegations of abuse/neglect arising out of the use of restraint and seclusion in schools and make recommendations on how to identify the abusive use of restraint. 1.8 Kentucky P&A will monitor facilities to ensure abuse/neglect reporting numbers are posted for residents as required by law and will review documents provided to children with disabilities in facilities (psychiatric hospitals, PRTFs, and DJJ facilities) on how to report allegations of abuse or neglect and make recommendations on how to ensure children with disabilities are able to report. (PADD, PAIMI, PAIR, PATBI) Angela and Whitney are leads. 1.9 Kentucky P&A will provide technical assistance to parents/guardians regarding responding to allegations of misuse of restraint and seclusion in schools. 2. Olmstead/Community Integration Kentucky P&A will represent persons institutionalized or at risk of institutionalization to ensure they have access to services and supports in the most integrated living arrangement. Individual Advocacy 2.1 Kentucky P&A will provide technical assistance to hospitals, DJJ workers, CDWs, nursing home workers, and DCBS workers regarding denial of or inability to access community services that lead to or increase a child with disabilities risk of institutionalization. 2.2 Kentucky P&A will provide technical assistance to parent/guardian of children with disabilities or represent children with disabilities who are institutionalized or at risk of institutionalization due to denial of or inability to access community services. 2.3 Kentucky P&A will represent or provide technical assistance to parent/guardian of at least two PAIR eligible children or adults living in or at risk of being placed 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. 2.4 Kentucky P&A will represent or provide technical assistance to at least two 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. Systemic Advocacy 2.5 Kentucky P&A will meet with Kentucky Medicaid and Kentucky Transitions regarding available services and the programs future. 2.6 Kentucky P&A will request the number of children, their location and the parents/guardian contact information of those children who are served out of state and whose services does Kentucky Medicaid pay. 3. Education PAIMI eligible children/youth will be provided a free and appropriate education (FAPE). 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). 3.2 Kentucky P&A will complete reviews of the education records of ¬¬ at least one PAIR eligible 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. 3.3 Kentucky P&A will provide technical assistance to the parent/guardian/caseworker of at least two PAIR eligible children/youth with disabilities regarding addressing violations of the child’s educational rights. Systemic Advocacy 3.4 Kentucky P&A will provide information to The Arc of Kentucky and KYSPIN to be included in trainings to parents/grandparents/foster parents on Special Education and related topics across Kentucky. 3.5 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 advocate for the educational rights of their children. 3.6 Kentucky P&A will work with KDE to produce a publication on Guardianship and the transition to adulthood with a target audience of individuals with disabilities approaching adulthood and their parents. 3.7 Kentucky P&A will monitor the development of a charter school system in Kentucky and participate as appropriate to ensure equal access and participation by children with disabilities. 3.8 Kentucky P&A will monitor and participate in the development of a new accountability system in Kentucky under the Every Student Succeeds Act (ESSA). 3.9 Kentucky P&A will identify five topics related to special education and develop publications and or webinars on those topics and post them online. 4. Health Care PAIMI eligible clients will have the right to access health care, including physical and behavioral services. Individual Advocacy 4.1 Kentucky P&A will represent at least one PAIR eligible Medicaid eligible adult, who is denied medical, dental, and other health services or whose services are reduced or terminated. 4.2 Kentucky P&A will represent at least one PAIR eligible 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. Systemic Advocacy 4.3 Kentucky P&A will review interpretation, implementation, policies and procedures of PASSR in Kentucky. 4.4 Kentucky P&A will post an online training on the interplay between Medicaid Waivers and EPSDT under new Medicaid law. 4.5 Kentucky P&A will contact the 14 CMHCs to discuss procedure for obtaining specialized services for nursing facility residents who have an intellectual or developmental disability. 5. Criminal Justice The rights of PAIMI eligible clients in the criminal justice system. Individual Advocacy 5.1 Kentucky P&A will provide technical assistance on ALL cases to DPA attorneys, Court Designated Workers, Parole Officers, and Cabinet Caseworkers representing youth or adults with disabilities who interface with the criminal justice system and request assistance. Systemic Advocacy 5.1 Kentucky P&A will continue to monitor the implementation of juvenile justice reform and investigate the ongoing changes to the juvenile justice system. 5.2 Kentucky P&A will review all policies and protocols regarding interaction with people with disabilities of the Kentucky State Police, Louisville Metro Police Department, Lexington Police Department and Hopkinsville Police Department. 5.3 Kentucky P&A will coordinate and present at Department of Public Advocacy quarterly meeting on crisis services in the community. 5.4 Kentucky P&A will identify employment status of School Resource Officers (SROs) from five districts (Scott, Woodford, Owen, Franklin, Anderson) and review training requirements and policies and procedures for those SROs. Angela and Robbin are leads. 6. Protect, Promote, and Exercise Rights Persons with disabilities will have access to goods/services/programs Individual Advocacy 6.1 Kentucky P&A will represent at least one PAIR eligible client with a disability, who is discriminated against related to their disability, in matters related to housing, post-secondary education, employment, and other, including access to goods/services/program provided by governmental agencies or entities. 6.2 Kentucky P&A will collaborate with Human Development Institute, Department of Aging and Independent Living and private guardians regarding Supported Decision Making as an alternative to guardianship. Systemic Advocacy 6.3 Kentucky P&A staff will monitor all draft and filed legislation (federal, state and local) that impacts Kentuckian’s with disabilities. 6.4 Kentucky P&A will update the webpage during the legislative 6.5 Kentucky P&A will collaborate with the Commonwealth Council on Developmental Disabilities to create disability-related information and referral system to develop resources and provide six trainings to 100 people regarding newly created ABLE accounts available to Kentuckians. 6.6 Kentucky P&A will collaborate with the Office for the Blind and other organizations to have assistance dogs included under KRS 525.200. Systemic Advocacy (d) Kentucky P&A and the Client Assistance Program (CAP) will meet monthly to collaborate. (PADD, PAIMI, PAIR, PATBI, PABSS) Jeff is lead (e)P&A will continue to participate as an active member of the Kentucky Interagency Transition Council. (PADD, PAIMI, PAIR, PAAT, PATBI) Robbin is lead. 7. Self-Advocacy PAIR eligible client will increase their knowledge of their rights and increase their ability to self-advocate Systemic Advocacy 7.1 Kentucky P&A advisory bodies will work with members of the Legislative and Executive branches to adopt the new icon for accessibility in all state properties and encourage local/county governments, colleges/universities and private business to do the same. 8. Outreach Outreach to underserved areas that provide services to PAIMI eligible clients Individual Advocacy 8.1 Kentucky P&A will represent two PAIR eligible clients from underserved disability, minority, or geographic groups/populations (i.e. Appalachia, LGBTQ, and Latino, Deaf/Hard of Hearing). Systemic Advocacy 8.2 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. 8.3 Kentucky P&A will participate in two non-disability related outreach events. 8.4 Kentucky P&A will collaborate with the Kentucky Commission for the Deaf and Hard of Hearing, the Department for Behavioral Health and service providers to create informative ASL videos with Closed Captions to inform the deaf and hard of hearing community of the services and resources available. (d)P&A will participate in four outreach efforts to underserved communities, including the Deaf/Hard Hearing and Latino communities.

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 2017 Grant Award: $201, 461.17 2016 Grant Award Carry Over: $ 24, 185.00 B. Budget for fiscal year covered by this report: Personnel Costs: $224, 329.64 Operating Expenses: Printing to State Agency: $19.50 Food Products: $49.18 In State Travel: $169.28 Out of State Travel: $78.57 Dues and Subscriptions: $1,000 Total Expenses: $225, 646.17 C. Description of PAIR Staff: There are 3.5 full time PAIR Staff at Kentucky P&A. This includes support staff who answer phone calls, enter intake information into DAD, and provide other support to Kentucky P&A staff and an attorney and disability rights advocates D. Involvement with advisory boards: While Kentucky P&A staff members participate on a number of advisory boards and councils with other state agencies; Kentucky P&A does not have a board or council solely devoted to PAIR activities. E. Grievances filed under the grievance procedure: There were not any grievances filed at Kentucky P&A in FY 2017. F. Coordination with the Client Assistance e Program (CAP) and the State long term care program: Kentucky P&A has a positive working relationship with the State Long Term Care Ombudsman Program and interfaces with the Program on a regular basis through participation on multiagency meetings and councils. Kentucky P&A receives referrals from the Long Term Care Ombudsman Program concerning residents residing in long-term care facilities. Jeff Edwards, Director of Kentucky, P&A, meets regularly with the State Long Term Care Ombudsman. Kentucky P&A collaborates with the Client Assistance Program and makes referrals to assist clients of the Office of Vocational Rehabilitation, Office for the Blind, and Independent Living Centers, projects with industry or employment programs in the state off Kentucky in identifying and receiving services.

Certification

Signed?Yes
Signed ByJeff Edwards
TitleDirector, Kentucky Protection and Advocacy
Signed Date12/15/2017