|Name||Disability Rights Iowa|
|Address||400 East Court Avenue|
|Address Line 2||Suite 300|
|Toll-free TTY||Relay 711|
|Name of P&A Executive Director||Jane Hudson, Executive Director|
|Name of PAIR Director/Coordinator||Cynthia A. Miller|
|Person to contact regarding report||Cynthia A. Miller|
|Contact Person phone||515-278-2502|
Multiple responses are not permitted.
|1. Individuals receiving I&R within PAIR priority areas||11|
|2. Individuals receiving I&R outside PAIR priority areas||330|
|3. Total individuals receiving I&R (lines A1 + A2)||341|
|1. Number of trainings presented by PAIR staff||19|
|2. Number of individuals who attended training (approximate)||708|
The following are 17 trainings conducted by DRI staff that related to the PAIR program in FY 18:
1. Hot Topics in Managed Care, NHelp Law Conference - DRI presented in a panel at the 2017 National Health Law Conference, alongside panelists from the New York Justice Center and NHelp. The training discussed developments in Medicaid managed care, including ongoing efforts to improve consumer protections and access, and the implementation of key elements of the managed care regulations concerning due process, transparency, oversight, and access.
2. Challenging behaviors training - DRI collaborated with Iowa Department of Education to present to 25 school administrators about the Individuals with Disabilities Education Act and how to work with students with challenging behaviors.
3. Candeo Substitute Decision Making Training - DRI provided training to management staff at one of Iowa’s largest providers of Home and Community Based Services. Subject of the training was substitute decision making, less restrictive alternatives to guardianship, and the rights of individuals who are under guardianship or conservatorship.
4. Training IACP Appeals and Grievance in Managed Care - DRI conducted a webinar training for Medicaid service providers on the laws and regulations pertaining to Medicaid grievances and appeals, and how to assist their clients with navigating the grievance and appeals process for Medicaid beneficiaries who have their services denied, reduced, or terminated by a Managed Care Organization.
5. ISBA Managed Care Appeals and Grievances - DRI presented to members of the Iowa State Bar Association, at the Elder Law track during the Bar’s annual meeting for attorneys. Subject of the training was the managed care appeals and grievance process, and how to represent clients receiving long term services and supports in community settings, when their services are reduced or terminated by the Managed Care Organization.
6. DART Central Station Training - DRI collaborated with Des Moines’ city bus service, DART, to produce a training video on barriers that disabled riders encounter in public transportation, and the use of the securement system on fixed route buses. The video will be used to train DART staff, and possibly to introduce disabled riders to the system as well.
7. Drake University Occupational Therapy Training - DRI trained a class of Occupational Therapy students at Drake University. Subject of the training was the barriers that people with disabilities encounter when seeking independent employment, and the work DRI does.
8. Training South Dakota P&A on Investigations - DRI traveled to Disability Rights South Dakota to train attorneys and advocates on best practices in investigations and monitoring. DRI held multiple half day trainings to train staff and responded to individual staff questions, requests for referral, and for technical assistance.
9. U of I Social Work training (2 trainings) - On two occasions, DRI presented to a class of Masters level Social Work students at the University of Iowa. Subject of the training was education on background of disability rights, the ADA, DRI’s work, and employment barriers people with disabilities face.
10.DART panel on accessible transportation - DRI presented on a panel with the local transportation agency about the importance of accessible transportation and paratransit for people with disabilities.
11.Great Prairie AEA Parental Rights in Special Education - DRI conducted training to educate parents about procedural safeguards and rights in different areas of special education law, including child find, consent to evaluation, independent educational evaluations, and behavior/discipline.
12.Training in Managed Care, Together We Can Conference - DRI conducted training for parents, providers, and professionals about Managed Care appeals and grievances, how to file, due process rights, appeal and hearing procedure in Managed Care appeals at a statewide conference for individuals with disabilities, parents and professionals.
13.ISBA Medicaid Appeals Panel - DRI participated in a panel discussion at the Iowa State Bar Association’s annual conference. Purpose of the panel was to answer questions of attorneys related to Medicaid such as eligibility, estate recovery, and managed care.
14.Medicaid Managed Care Grievance and Appeals for PWP - DRI conducted a webinar training for parents and providers of people with disabilities to educate them on how to pursue appeals and hearings under Managed Care when services are reduced or terminated.
15.Mosaic Substitute Decision Making training - DRI conducted training of staff at a local provider of Home and Community Based Services. Subject of the training was substitute decision making, less restrictive alternatives to guardianship, and the rights of individuals who are under guardianship or conservatorship.
16.Special Education Unified Therapy - DRI trained parents on frequently asked topics in special education law, rights of students with disabilities under IDEA and Iowa law.
|1. Radio and TV appearances by PAIR staff||10|
|2. Newspaper/magazine/journal articles||23|
|3. PSAs/videos aired||0|
|4. Hits on the PAIR/P&A website||62,725|
|5. Publications/booklets/brochures disseminated||2,304|
|6. Other (specify separately)||1|
A DRI staff attorney with a service dog wrote a publication disseminated in the DRI news letter to train readers about the myths and realities of service dogs and their use.
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)||12|
|2. Additional individuals served during the year||28|
|3. Total individuals served (lines A1 + A2)||40|
|4. Individuals w. more than 1 case opened/closed during the FY. (Do not add this number to total on line A3 above.)||1|
Carryover to next FY may not exceed total on line II. A.3 above 9
|1. Architectural accessibility||7|
|3. Program access||1|
|5. Government benefits/services||4|
|8. Assistive technology||2|
|10. Health care||11|
|12. Non-government services||0|
|13. Privacy rights||0|
|14. Access to records||0|
|1. Issues resolved partially or completely in individual favor||25|
|2. Other representation found||0|
|3. Individual withdrew complaint||2|
|4. Appeals unsuccessful||2|
|5. PAIR Services not needed due to individual's death, relocation etc.||0|
|6. PAIR withdrew from case||1|
|7. PAIR unable to take case because of lack of resources||0|
|8. Individual case lacks legal merit||1|
DRI had one case that was closed due to no contact.
List the highest level of intervention used by PAIR prior to closing each case file.
|1. Technical assistance in self-advocacy||1|
|2. Short-term assistance||13|
|5. Mediation/alternative dispute resolution||2|
|6. Administrative hearings||5|
|7. Litigation (including class actions)||2|
|8. Systemic/policy activities||0|
|1. 0 - 4||1|
|2. 5 - 22||2|
|3. 23 - 59||24|
|4. 60 - 64||5|
|5. 65 and over||8|
Multiple responses not permitted.
|1. Hispanic/Latino of any race||0|
|2. American Indian or Alaskan Native||0|
|4. Black or African American||1|
|5. Native Hawaiian or Other Pacific Islander||0|
|7. Two or more races||0|
|8. Race/ethnicity unknown||0|
Multiple responses not permitted.
|2. Parental or other family home||2|
|3. Community residential home||1|
|4. Foster care||0|
|5. Nursing home||3|
|6. Public institutional living arrangement||0|
|7. Private institutional living arrangement||0|
|8. Jail/prison/detention center||3|
|10. Other living arrangements||0|
|11. Living arrangements not known||0|
Identify the individual's primary disability, namely the one directly related to the issues/complaints
|1. Blind/visual impairment||1|
|2. Deaf/hard of hearing||4|
|4. Orthopedic impairment||17|
|5. Mental illness||0|
|6. Substance abuse||0|
|7. Mental retardation||0|
|8. Learning disability||0|
|9. Neurological impairment||3|
|10. Respiratory impairment||1|
|11. Heart/other circulatory impairment||0|
|12. Muscular/skeletal impairment||3|
|13. Speech impairment||0|
|15. Traumatic brain injury||3|
|16. Other disability||8|
|1. Number of policies/practices changed as a result of non-litigation systemic activities||3|
|2. Number of individuals potentially impacted by policy changes||50,300|
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.
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.
Systemic Appropriate Accommodations for Deaf Individuals (Policy change - 200) - DRI completed a thorough investigation into the provision of appropriate accommodations for incarcerated individuals with hearing disabilities in Iowa's prisons by conducting several monitoring visits, and interviewing prisoners through interpreters as needed. DRI found that these individuals were not being provided with qualified interpreters when required/appropriate, not provided with appropriate communication devices such as TTY/video phones, and not provided with appropriate screening to identify or confirm hearing disabilities. DRI completed a detailed findings letter and met with the Department of Corrections to discuss needed changes in policy and practice. The DOC created a new policy and will now provide qualified interpreters for all necessary meetings such as medical appointments, disciplinary hearings, parole hearings, programming meetings, and orientation. The DOC is also installing video phones in facilities housing individuals who communicate using ASL, and will have operational TTYs accessible to individuals with the same ease as regular telephones. Additionally, hearing evaluations will be provided and assistive devices and their operational components will be provided to individuals without regard to their ability to pay for them.
Systemic Change in AEAs (systemic change - 50000) - DRI participated in meetings with multiple districts and Area Education Agency staff. DRI collaborated with an area education agency to ensure district-wide training for a school district that had problems with using inappropriate restraint and seclusion on students. The training included methods to reduce the use of restraint and seclusion as well as the regulatory requirements under the Iowa Administrative Code.
Johnson County Jail Juvenile Offenders (systemic change - 100) - DRI met with the Johnson County Juvenile Defender and a local community organizer to understand the cause of youth being sent to adult jails, specifically that it was an alleged unwritten policy of the Johnson County Sheriff. DRI monitored the common adult county jails used to house juveniles, as well as all juvenile detention facilities in the state. During each monitoring DRI asked who made the decisions regarding adult waived youth placement, what policies exist regarding adult waivers, and what services are offered. DRI learned that a lack of continuity exists regarding adult waiver decisions and that most juvenile detention centers will take most, if not all adult waivers. DRI will use this increased knowledge to continue to advocate that nearly all adult waived youth should be held in detention. At the conclusion of this project DRI received information from the juvenile defender that the sheriff seemed to have altered his practice of automatically sending juveniles charged with certain offenses to adult jails, as a result of scrutiny from DRI and other entities questioning this practice.
ILAST Community Response to Elder Abuse - DRI attended multiple meetings of the CCR team and provided input and referrals to team. Additionally DRI staff attended a full day training entitled "Abuse in Later Life: Cross-Training for Victim Service Providers" to improve our internal knowledge and response concerning elder abuse. We provided input and referral information in specific scenarios and our involvement also generated several requests for service or information to intake. Finally, staff attended a full-day training focused on response to Elder Abuse for victim service organizations such as DRI, to improve our institutional knowledge of the issue and our response to related complaints.
Collaboration on Jail and Prison Reform - DRI staff attended various organizational and work-group meetings consisting of other advocacy agencies focused on the reform of correctional systems in Iowa (prisons and jails)including meetings of the Iowa Therapeutic Alternatives to Incarceration group and the Board of Corrections. DRI staff contributed in discussion and identification of systemic issues and solutions, and networked with representatives of the other advocacy agencies.
Iowa Commissions of Persons with Disabilities - DRI staff attended quarterly meetings and concluded a four year appointment to this commission on the rights of people with disabilities.
Disability Rights Bar Association Board Member - A Disability Rights Iowa staff member continues to serve as a board member on the Disability Rights Bar Association.
DOC Critical Incident reports - DRI reviewed hundreds of Critical Incident Reports (CIRs) produced by the Department of Corrections. Each report was screened, and assessed if it involved a person with a known disability or a disability related issue. Disability related CIRs were flagged, and categorized for follow up, and by type of incident (Seizure, Self Harm, Use of Force, M-Unit, Assault on staff or others, and incidents occurring in the Forensic Psychiatric Hospital). This information was used both to open individual investigations (including an investigation into physical abuse/excessive force on one offender, and also to inform DRI concerning offender complaints/requests for service including a file which resulted in physical accommodations for an individual. Finally, this information was used to inform staff on systemic issues, and issues to focus on during monitoring of prison facilities.
|1. Number of individuals potentially impacted by changes as a result of PAIR litigation/class action efforts||15,742|
|2. Number of individuals named in class actions||6|
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.
FY18 Medicaid managed care class action:
In FY17, DRI filed a class action on behalf of Iowa Medicaid beneficiaries with intellectual disabilities, physical disabilities and brain injuries who receive home and community based services from one of three waiver programs. Plaintiffs sought declaratory and both preliminary and permanent injunctive relief to halt the terminations and reductions of home and community-based services by Defendants and their agents until there is compliance with the requirements of the Medicaid Act, the U.S. Constitution, Iowa Constitution, the Americans with Disabilities Act and Section 504 of the Rehabilitation Act. Plaintiffs also petitioned for class certification.
In FY18, the court denied without prejudice the request for class certification on November 21, 2017, stating Plaintiffs’ proposed class failed to meet requirements of Rule 23(a). The court later denied the request for preliminary injunction on November 28, 2017 stating relief cannot be granted as the court denied certification of the class and the relief sought only applied to the proposed class.
On February 2, 2018, the court dismissed the class action lawsuit against the state of Iowa's Department of Human Services director. The judge ruled that as managed care organization AmeriHealth Caritas of Iowa has ceased operating in Iowa in November 2017 and all named plaintiffs were with this MCO, the Plaintiffs claims are moot.
DRI disagreed with the judge’s decision but chose not to appeal to the 8th Circuit. DRI continued to review for compliance with the HCBS waivers and services for Iowans with the remaining MCOs and filed individual appeals when appropriate.
DRI also represented twin brothers who were under the guardianship and conservatorship of their older brother. DRI’s clients had mild intellectual and physical impairments since birth, but both were highly independent - they held full time jobs, owned a home in the community, and required no assistance with medical decision making. Their relationship with their brother/guardian was poor and he refused to relinquish guardianship and conservatorship. After their first attorney told them they did not have a good case, they fired him and hired DRI. DRI represented them in litigation that ultimately settled on the first day of trial with the guardian-conservator agreeing to withdraw, terminate the guardianship, and have a third party professional conservator of the clients’ choice appointed in a very limited oversight role.
For each of your PAIR program priorities for the fiscal year covered by this report, please:
Abuse and Neglect:
1. Priority: Keep Iowans with Disabilities Safe
2. Need Addressed: Working to reduce abuse and neglect in facilities, by investigating and monitoring is a core function of Disability Rights Iowa. Abuse and neglect is any act or failure to act, by a person with a duty to care for an individual with a disability in a facility or service setting, which caused or may have caused an injury or death. Facilities and service settings are locations where individuals with disabilities receive services such as treatment, programming, or residential supports.
3. Description of activities: DRI will conduct individual investigations into suspected abuse or neglect, including deaths and injuries of individuals with disabilities resulting from abuse or neglect in institutional and HCBS settings. DRI will monitor facilities or service settings with allegations of abuse or neglect, with histories of the same, or as a matter of routine course. DRI will provide rights trainings to individuals residing at the mental health institutes and a self-advocacy training to individuals with mental illness. DRI will provide individual advocacy including technical assistance, negotiation, or other assistance, to protect the rights of individuals with disabilities receiving services in facilities or service settings. DRI will provide individual representation including injunctive or administrative interventions. DRI will collaborate with the Department of Inspections and Appeals, the Long-Term Care Ombudsman and others to prevent abuse or neglect. DRI will work to improve the investigations of other enforcement and oversight agencies when they are inadequate, and issue public reports, where appropriate, to create systemic change.
4. Collaboration: See section IV-A for details of DRI’s collaboration on the ILAST Community Response to Elder Abuse. Also see section VI for collaboration with state long term care ombudsman.
5. Number of cases: 1 Class Actions: 0
6. Case summary: The client was an 85 year old woman with dementia, COPD, and chronic heart failure. The client was living in a nursing facility when she received injuries of an unknown origin, a cut to her foot and a broken rib. DRI was originally contacted by the woman’s daughter who had power of attorney, but she did not respond to follow up calls. DRI went to the facility to visit the woman, but she had died of natural causes before we arrived. The facility confirmed her injuries and provided information. DRI reviewed the information and determined the injuries should have been reported to the state Department of Inspections and Appeals. We reported this finding to the facility and to DIA for evaluation and final opinion. Based on DRI’s work, DIA agreed to investigate the matter.
DRI also conducted 14 monitorings of facilities.
1. Priority: Ensure Access to Services and Places
2. Need Addressed: Disability Rights Iowa remains committed to ensuring people with disabilities are given the opportunity to be full participants in every area of community life. However, we understand that opportunity in many cases is dependent on the availability of dependable and accessible transportation. Thousands of Iowans rely on accessible public and private transportation to meet their professional, personal, and recreational needs, and the capacity of those systems to meet demand are often woefully inadequate. Systemic deficits in both service coverage, and quality limit the opportunity for people with disabilities to fully intact with their communities, in violation of the core principle of inclusion, which is the basis of the Americans with Disabilities Act.
3. Description of activities:
a. DRI will work to expand the access of individuals with disabilities to public and private transportation in the State of Iowa. To accomplish this, DRI will research access to transportation issues in Iowa and identify any limitations to employment, recreation or other types of personal needs; research state and federal law and cases involving accessibility of public and private transportation; Write a report with the information obtained on accessibility issues for individuals with disabilities in urban and rural areas of Iowa; Collaborate with grass roots groups and civil rights commissions throughout Iowa to draw attention to the issue; Meet with and provide training to transit providers regarding their obligations under the ADA and other accessibility laws; Represent individuals or groups of individuals in administrative hearings or legal actions regarding the failure of a public or private transportation entities to comply with the ADA or other accessibility laws; Identify solutions to implement accessible and dependable transportation within the greater metro, with the aim of eventually expanding and refining this model to rural communities.
b. DRI will enforce the right of individuals with disabilities to have equal opportunities to access state and local government services, programs and activities. DRI will ensure that the state and municipalities of Iowa have an ADA coordinator; a self-evaluation, and a transition plan to bring their aids, benefits and services in compliance with the Americans with Disabilities Act, with attention paid both to physical accessibility as well as program access; Survey at least 10 smaller cities or towns to determine whether they are in compliance with the ADA with respect to physical disability and accessibility of materials; Provide individual and systemic legal advocacy concerning denial of equal access to state/local government services or other Title II public entities; Educate a diverse collection of community leaders on the benefits of incorporating universal design as a foundational element of community development, and advocate for its use statewide.
c. DRI will enforce the right of individuals with disabilities to places of public accommodation, including but not limited to auditoriums, convention centers, lecture halls, or other place of public gathering. DRI will survey places of places of public gathering in at least three geographical areas in Iowa. including both rural and urban settings; provide trainings and technical assistance to owners and operators of places of public gathering; Collaborate with civil rights commissions and other municipal entities to ensure accessibility is considered as cities and smaller communities approve licenses and plans for places of public gathering; Provide legal advocacy or litigate cases concerning denial of equal access to places of public gathering.
4. Collaboration: See Section IV-A for details of DRI’s collaboration with the DOC to ensure hearing access for inmates in Iowa’s prison’s and jails.
5. Number of cases: 6 Class actions: 0
6. Case summary: The client is a 54 year old man with hearing impairment. The client was facing criminal charges and had been denied access to an assistive listening device so he could participate in court proceedings. DRI contacted the ADA coordinator in the judicial district where the client was being tried, and worked to ensure the client would receive an assistive listening device for the duration of the proceedings against him. As a result of DRI’s work, staff, attorneys, and judges who work in that judicial district are better educated on the rights of defendants with hearing impairments and have a procedure in place to provide access and assistive technology where necessary.
1. Priority: Protect the Rights of Iowans to Live in the Most Integrated Setting
2. Need Addressed: Individuals with disabilities have the right under the Americans with Disabilities Act and the U.S. Supreme Court’s Olmstead decision to receive services in the most integrated settings within a reasonable timeframe.
3. Description of activities:
a. DRI will work to increase the options of adults who want to live in the community rather than facilities to successfully transition to the community. To accomplish this, DRI will research and acquire knowledge of federal law regarding community integration of individuals in nursing facilities (MDS section Q referral process); Engage in meetings with Managed Care Organizations to monitor efforts being made to increase capacity of community based services system and hold them accountable for Olmstead violations when indicated; Represent individuals residing in nursing facilities or intermediate care facilities who wish to return to the community and are not receiving adequate transition planning; Review Pre-Admission Screening and Resident Review (PASRR) Level II Specialized Services and Care Plans of individuals in Nursing Facilities to ensure specialized services that would assist individuals in returning to the community are in place; Educate residents of nursing facilities and intermediate care facilities for individuals with intellectual disabilities about rights, including the right to participate in decisions about where they live and what services they receive and; Conduct monitoring of nursing facilities and intermediate care facilities for individuals with intellectual disabilities.
b. DRI will work to increase the opportunities of adults on home and community-based service waivers, in settings where services are received 24 hours a day, to live and work in the community, have control over daily life decisions and choose what services they receive and who provides them. DRI will gain full understanding of state and federal oversight of HCBS Waiver programs; Provide advocacy to persons not receiving appropriate HCBS services; Monitor Iowa’s adherence to Statewide Transition Plan; Evaluate compliance with CMS’ home and community-based settings rule and take appropriate action to ensure compliance with the rule, including requesting Iowa Medicaid Enterprises to submit a setting through the heightened scrutiny process and; Monitor at least 6 24 hour HCBS settings.
4. Collaboration: See section I-B for details of collaboration with Iowa State Bar Association to educate attorneys about appeal and grievance rights of individuals receiving home and community based services to ensure they are able to continue to live outside of institutions, and have their needs met in an integrated setting.
5. Number of cases: 3 Class actions: 0
6. Case example: The client is a 59 year old woman with peripheral neuropathy. She has mobility impairments that require the assistance of home health aids through Medicaid. She contacted DRI because her home health agency was refusing to provide service on holidays, which had the effect of leaving the client restricted to her bed and unable to attend to toileting and personal hygiene needs. DRI worked with the client and the agency to attempt to identify other sources of service that could meet her needs. The client worked with the with assistance of her case manager to locate other sources and services.
1. Priority: Protect the Rights of Students with Disabilities
2. Need Addressed: Students with challenging behaviors related to their disability need to be in school and in their classroom all day so that they can receive specially designed instruction from qualified special educators. An appropriate behavior intervention plan not only helps a student access the general education curriculum but it also is the foundation for a successful transition to the community and post-secondary work. Research has shown that frequent use of suspensions or expulsions has no educational benefit, is strongly associated with low achievement, increases the risk of a student dropping out, and creates a greater likelihood of juvenile justice involvement. The use of seclusion and restraint, especially when it happens again and again for long periods of time, represents a failure of the behavior intervention plan. Students with disabilities are required by Iowa code to begin developing a transition plan at age 14. Standards set by the IDEA have been broken into three categories by the Iowa Department of Education living, learning and working. The three categories need to be meaningfully addressed in order to successfully transition to life in the community following the completion of graduation requirements. It is important to build the capacity of the Iowa attorney bar for parents/students so that there is more access to more skilled representation in the dispute resolution process in the Individuals with Disabilities in Education Act (IDEA). This, in turn, will lead to more positive educational outcomes for students with disabilities.
3. Description of Activities: DRI will provide suspended students assistance and legal advocacy developing appropriate goals and behavioral intervention plans that reduce the use of restraint, seclusion, and other exclusionary disciplinary measures. DRI will collaborate with the DOE, AEAs, and local education agencies to effect systemic change. DRI will work to ensure students in need of transition planning are receiving skill building and interest/work assessments, and provide legal advocacy/assistance to students whose transition plans were inadequately designed or implemented. If necessary, DRI will file due process or state complaints on behalf of individual students and their families. DRI will also work to train attorneys and law students on special education law and provide them technical assistance.
4. Collaboration: See section I-B for details of training provided to school administrators and AEA employees about IDEA and student rights, and section IV-A for systemic work with AEAs to reduce inappropriate use of restraint and seclusion in schools.
5: Number of cases: 0 Class actions: 0
6. Case summary: DRI did not have any education cases under PAIR in FY18. See systemic projects.
1. Priority: Remove Barriers to Employment
2. Need Addressed:
Individuals can do real work if they receive sufficient supports, services and reasonable accommodations. However, many individuals with disabilities wind up in sheltered workshops where only people with disabilities work—often at wages below minimum wage. Many of these individuals have realistic job expectations and prefer to do work where they have contacts with individuals without disabilities in the community. Congress enacted the Americans with Disabilities Act to prohibit discrimination against individuals with disabilities who can perform jobs, with reasonable accommodations or modifications of employment policies. However, many individuals with disabilities still experience discrimination or barriers to work. Therefore, it is important for DRI, as the protection and advocacy agency for Iowans with disabilities, to challenge discrimination so that individuals with disabilities can get and keep jobs and assist in an individual’s efforts to return to work.
3. Description of activities:
a. DRI will work to stop employment discrimination because of a disability and remove barriers to work. DRI will teach applicants and employees how to file complaints with the Iowa Civil Rights Commission; Provide legally-based advocacy or representation to applicants or employees who need reasonable accommodations in their workplace or who have been terminated because of their disability;
4. Collaboration: See section I-B for details of collaboration with local universities to educate occupational health and social work students about employment barriers faced by people with disabilities
5. Number of cases: 5 Class Actions: 0
6. Case summary: The client is a 40 year old woman diagnosed with fibromyalgia, arthritis, chronic plain. Client works as a writer and editor for a company that authors college course materials and needs to able to work from home several days a week, but her employer will not allow it but provides no explanation why it is an undue hardship. She is seeking assistance requesting and negotiating accommodations and enforcing her rights. DRI gave client guidance on her rights and how to request and negotiate accommodations. Offered assistance with contacting employer directly or filing ICRC complaint if necessary. Client declined direct contact with employer, fearing retaliation. Following several meetings, employer modified client’s accommodations and allowed her to work from home three days per week, which was adequate to allow her to perform her job’s essential functions.
1. Priority: Reducing the number of Iowans with unnecessary or overly restrictive substitute decision makers.
2. Need addressed: People with disabilities are at disproportionate risk of having their right to make their own decisions and control their own lives stripped by courts or family members who believe their disability makes them incapable of doing so, or exposes them to risk of harm or exploitation. Though guardianships are intended to be limited and imposed only as a last resort, less restrictive alternatives and the legal obligations of guardians, their attorneys, and courts, are too often overlooked in practice.
3. Description of Activities: DRI will conduct outreach and training to schools, providers, and families to educate on alternatives to guardianship and supported decision making, and attend meetings of the Supreme Court’s Guardianship Reform Task Force. DRI will represent individuals to assist with terminating or resisting establishment of unnecessary or abusive guardianships/conservatorships or other substitute decision makers. DRI will create a basic guardianship training for attorneys to represent wards or prospective wards and provide technical assistance, and create resources for adult wards who want to self-advocate for less restrictive alternatives.
4. Collaboration: See section I-B for details of trainings provided to local provider agencies on the rights of people under guardianship or conservatorship and less restrictive forms of substitute decision making. This has been an ongoing collaboration with providers across the state that routinely results in individual referrals for representation to modify or terminate guardianships.
5. Number of Cases: 3 Class actions: 0
6. Case summary: Client is a 52 year old man with traumatic brain injury from a car accident. Client’s wife is his court appointed guardian and conservator, but they are estranged and do not get along. Client reports his wife has been misusing his money and refuses to account for it, restricts his freedom without justification, and denies him access to their kids when he does not do what she wants. DRI represented client in a successful termination of the guardianship and conservatorship, and filed a detailed objection to the conservator’s misuse of assets. Client initiated divorce proceedings separately with outside counsel. Due to conservator likely being judgment proof, client and conservator agreed to incorporate and resolve the misuse of conservatorship assets in the divorce proceeding.
1. Priority: Protect Access to Long-Term Services and Supports
2. Need Addressed: Iowa has recently privatized its Medicaid system. Medicaid recipients have many concerns about whether they will have the services they need under managed care, especially individuals receiving long-term services and supports.
3. Description of activities: DRI will provide legal representation in the grievance and appeal processes and in state fair hearings to individuals for whom specific long-term care services have been denied, reduced or terminated; address any systemic issues in managed care that are uncovered through advocacy or litigation (e.g. MCO’s not providing notice of decisions); provide advocacy to individuals needing long-term care services and who are on home and community-based waiver waiting lists to receive home and community-based services more promptly and; monitor managed care companies (MCOs) compliance with their contractual obligations with the State of Iowa to provide adequate long-term care services and supports in order to increase the number of individuals living in community based settings.
4. Collaboration: See Section VI for details of DRI’s collaboration with the state Managed Care Ombudsman.
5. Number of cases: 9 Class actions: 0
6 Case summary: The client is a 104 year old woman with physical disabilities and mobility impairments receiving services under the Home and Community Based Services Elderly Waiver. Client’s son provides consumer directed attendant care services to ensure she can continue to live at home and does not have to be institutionalized. Client’s services were reduced by her managed care organization despite no change in her needs or condition. DRI filed an appeal on her behalf and the MCO agreed to restore her services.
1. Priority: Enforce the right of people with disabilities to have equal access to housing and increase affordable housing options.
2. Need addressed: Individuals with disabilities may experience a denial of equal access to public housing or encounter a landlord who will not provide a reasonable accommodation or otherwise discriminate against them due to a disability. In addition, on DRI’s public survey, approximately 70% of the people responding stated that DRI needs to focus on strategies to get more affordable housing for individuals with disabilities. As Priced Out 2014, a report published by the Technical Assistance Collaborative, Inc. and the Consortium for Citizens with Disabilities, Housing Task Force stated: There are few groups more adversely affected by rising rental costs and the acute shortage of decent, affordable rental homes than those non-elderly adults with serious and long-term disabilities who rely on SSI for their income. This unfortunate situation forces hundreds of thousands of people with disabilities to forego having a home of their own and to choose between homelessness or placement in a segregated and restrictive institutional setting.
3. Description of activities: DRI will represent individuals with disabilities whose landlords are not providing them with reasonable accommodations, or who have been or are about to be evicted based on their disabilities. DRI will participate in affordable housing coalitions in Iowa and research federal or state law on legal strategies to increase affordable housing
4. Collaboration: DRI collaborated with six Des Moines-area Home and Community Based Service providers whose clients were threatened with eviction or denial of housing by a prominent property management company that adopted an overtly discriminatory policy of denying lease renewal or rental applications by any tenant receiving HCBS services from the six providers. DRI drafted a letter to the company’s vice president enumerating the violations of the Iowa Civil Rights Act and Fair Housing Act and demanding it cease and desist from enforcing the policy. The company’s attorney responded that it had made an error by adopting the policy and would agree to immediately rescind it.
5. Number of cases: 4 Class actions: 0
6. Case summary: The client is a 71 year old woman with physical disabilities and mobility impairments. The client’s landlord refused her request for an accommodation to let her to keep an attached garage parking space that was close to her apartment and allowed her access to the garage despite her mobility impairments. Shortly after her request was denied, the client was issued a notice that her lease was non-renewed after several years living in the same apartment. DRI represented the client in a housing discrimination complaint alleging failure to accommodate and retaliation. After the civil rights commission found probable cause of discrimination, the property owners entered into mediation and DRI negotiated a favorable settlement for the client to cover the cost of her relocation and some damages, plus attorneys fees.
Prisons and Jails
1. Priority: Protect the rights of incarcerated Iowans
2. Need addressed: Individualswithdisabilitiesareoverrepresented in thecriminaljusticesystem.Onceincarceratedtheseindividualsarevulnerabletoabuse andneglect,suchasexcessiveusesofforce,denialofaccesstonecessarytreatment,orhousing in longterm segregation. Inmates with disabilities who are incarcerated should not suffer harsher conditions of incarceration simply as a result of their disabilities. The Americans with Disabilities Act embodies a national policy of nondiscrimination against individuals with disabilities and applies to prisons and jails, requiring that qualified inmates with disabilities be afforded reasonable accommodations and modifications to policies and procedures.
3. Description of activities: DRI will monitor at least two prisons and two jails to detect abuse, neglect, or systemic issues affecting inmates with disabilities. DRI will investigate, provide individual advocacy, or provide other appropriate assistance including representation or systemic advocacy to prevent or end abuse and neglect of prisoners. DRI will conduct individual investigations into allegations of denial of access to legally required mental health care and medications, and provide advocacy to ensure provision of these services. DRI will Conduct individual investigations into suspicious deaths in prisons and county jails Provide individual advocacy to obtain accommodations for inmates denied access to prison programs and services as a result of physical inaccessibility or denial of reasonable assistive devices. DRI will monitor at least two prisons and two jails to ensure physical accessibility. DRI will work to increase staff knowledge of physical accessibility standards for prisons and jails.
4. Collaboration: See case example below for description of collaboration with Department of Corrections to correct systemic denial of accommodations for incarcerated persons with hearing impairments.
5. Number of cases: 2 Class actions: 0
6. Case summary: The client is a 36 year old transgender offender with hearing impairment, who wrote to DRI stating that she was not receiving appropriate interpretation services for programming and other meetings, as well as a general lack of appropriate accommodations, while incarcerated at the Iowa Medical Classification Center. DRI provided legal advocacy on behalf of the individual to ensure the appropriate accommodations were provided. DRI staff attorneys met with leaders in the Department of Corrections (DOC) administration on multiple occasions to discuss the ADA requirements and reasonable accommodations. The DOC ultimately provided a certified interpreter for programming, purchased video phone equipment, and provided a tablet that provided speech to text services for times when an interpreter was not available. Upon completion of required programming with an interpreter, offender paroled to a halfway house run by the DOC. DRI advocated for the offender to continue to receive the appropriate accommodations and services during the remainder of her time in community corrections.
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:
Abuse and Neglect
1. Priority: Keep Iowans With Disabilities Safe
2. Need addressed: Working to reduce abuse and neglect in facilities, by conducting abuse and neglect investigations. Improving the investigations of other enforcement and oversight agencies and issues public reports, where appropriate, to create systemic change. Determine a facility’s compliance with respect to the rights and safety of residents by conducting monitoring visits to facilities. Monitoring facilities or service settings with allegations of abuse or neglect, with histories of the same, or as a matter of routine course. Ensuring that an independent entity investigates abuse and neglect in home and community-based service settings. Ensuring that individuals living in home and community-based settings are safe and have their rights protected.
3. Description of Activities: DRI will conduct individual investigations into suspected abuse or neglect, including deaths and injuries of individuals with disabilities resulting from abuse or neglect. DRI will provide, information, referrals, and individual advocacy including technical assistance, negotiation, legal or other assistance, to protect the rights of individuals with disabilities or mental illness receiving services in facilities or service settings. DRI will monitor at least three (3) residential care facilities; both mental health institutes, both state resource centers, an additional three (3) intermediate care facilities for individuals with intellectual or developmental disabilities, one (1) provider of services for individuals with traumatic brain injuries, and three (3) nursing facilities. DRI will provide rights and self-advocacy information, on an individual basis, to individuals residing in the facilities monitored. DRI will conduct individual investigations into suspected abuse or neglect of service recipients by HCBS providers, including deaths and injuries of individuals with disabilities resulting from abuse or neglect; DRI will provide individual representation or advocacy including technical assistance, negotiation, or other assistance, to protect HCBS service recipients’ rights related to abuse and neglect. DRI will conduct monitoring visits to at least six (6) home and community settings.
1. Priority: Ensure access to services and places
2. Need addressed: Ensuring Iowans with disabilities have access to government services, programs and activities under Title II of the Americans with Disabilities Act. Ensuring people with disabilities have access to places of public accommodation under Title III of the Americans with Disabilities Act.
3. Description of Activities: DRI will provideindividualandsystemiclegaladvocacyconcerningdenialofequalaccesstostate/localgovernmentservicesorotherTitleIIpublic entities. DRI will work to enforce the right of students with disabilities to reasonable accommodations. DRI will surveyplacesofplacesof publicaccommodationinatleastthreegeographicalareasinIowa. DRI will providetrainingsandtechnicalassistancetoownersandoperatorsofplacesofpublicaccommodation. DRI will providelegaladvocacyor litigatecasesconcerningdenialof equalaccesstoplacesofpublic accommodation.
1. Priority: Protect the rights of Iowans to live in the most integrated setting
2. Need addressed: Individuals with disabilities have the right under the Americans with Disabilities Act and the U.S. Supreme Court’s Olmstead decision to receive services in the most integrated settings within a reasonable timeframe.
3. Description of Activities: DRI will represent individuals residing in nursing facilities to ensure that nursing facilities are implementing federallawregarding discharge planning and transitions to community based settings. DRI will representindividualsresiding inintermediatecarefacilitieswhowishto returnto thecommunityand arenotreceiving adequatetransition planning. DRI will ReviewPre-Admission Screening and ResidentReview(PASRR)LevelIISpecializedServicesand Care Plansofindividualsin Nursing Facilitiesto ensure specialized servicesthatwould assistindividualsin returning tothecommunity arein place. DRI will educateresidentsof nursing facilitiesand intermediatecarefacilitiesforindividualswith intellectualdisabilitiesaboutrights,includingtherighttoparticipate in decisionsaboutwheretheyliveandwhatservicestheyreceive. DRI will continue to monitor state and federal oversight of HCBS Waiver programs, provide advocacy to persons not receiving Person Centered Planning, monitor compliance with CMS’ home and community-based settings rule and take appropriate action to ensure compliance with the rule, including requesting Iowa Medicaid Enterprises to submit a setting through the heightened scrutiny process, and monitoring 24 hour HCBS settings to identify individuals who are not receiving person centered planning.
1. Priority: Remove barriers to employment
2. Need addressed: Individuals can do real work if they receive sufficient supports, services and reasonable accommodations. However, many individuals with disabilities wind up in sheltered workshops where only people with disabilities work—often at wages below minimum wage. Many of these individuals have realistic job expectations and prefer to do work where they have contacts with individuals without disabilities in the community. Congress enacted the Americans with Disabilities Act to prohibit discrimination against individuals with disabilities who can perform jobs, with reasonable accommodations or modifications of employment policies. However, many individuals with disabilities still experience discrimination or barriers to work. Therefore, it is important for DRI, as a law firm for Iowans with disabilities, to challenge discrimination so that individuals with disabilities can get and keep jobs and assist in an individual’s efforts to return to work.
3. Description of activities: DRI will provide legally-based advocacy or representation to applicants or employees who need reasonable accommodations in their workplace or who have been terminated because of their disability.
Supported Decision Making
1. Priority: Support less restrictive alternatives to guardianship and conservatorship
2. Need addressed: Peoplewithdisabilitiesare atdisproportionate riskofhavingtheir righttomake theirowndecisionsandcontroltheir ownlives strippedbycourtsorfamilymemberswhobelieve theirdisabilitymakesthemincapableofdoingso, orexposesthemtoriskof harm or exploitation. Althoughguardianships and conservatorshipsare intendedto be limitedand imposedonlyasa lastresort,lessrestrictivealternativesandthelegalobligationsofguardians, conservators, and theirattorneys,andcourts,aretoooftenoverlooked inpractice.
3. Description of Activities: DRI will conduct outreach to schools, providers and families to educatefamiliesofchildren with disabilities turning age18about alternatives to guardianship and supported decision-makingoptions. DRI will attend themeetings of the Iowa State Bar Association andoffer suggestionsthatsupportlessrestrictivealternativestoguardianship/conservatorship, and participate in the Institute on Guardianship and Conservatorship to continue the discussion on reform and education where the task force leaves off. DRI will advocate for supported decision-making, and providelegalrepresentation toindividualstoassistwith terminating, modifyingor resistingestablishmentof unnecessary or abusiveguardianships/conservatorships or othersubstitutedecisionmakers(i.e.representativepayees). DRI will Createan AlternativestoGuardianship pageonDRI’swebsitewithformsand guidanceforself-representation and self-advocacy; and develop resourcesforadultsunderguardianship whowanttoself-advocateforlessrestrictivealternatives.
1. Priority: Protect access to long term services and support
2. Need addressed: Iowa has privatized its Medicaid system. Medicaid recipients have experienced many issues in the delivery of necessary services under managed care, especially individuals receiving long-term services and supports. This subjects people currently living in the community at risk of unnecessary institutionalization and segregation due to cost-cutting measures and flawed implementation of the service delivery system. Also, since 2011, parent coalitions, advocates and state task forces have identified problems with the children’s mental health system in Iowa. Under the Early Periodic Screening Diagnosis and Treatment (EPSDT) provisions of the Medicaid Act, children under the age of 21 have the right to receive medically necessary treatment, including, but not limited to crisis services, mental health counseling, case management and in-home services and supports. Iowa children and adolescents need adequate, effective, and appropriate services to correct or ameliorate their conditions.
3. Description of activities: DRI will Provide legal representation in the grievance and appeal processes including but not limited to state fair hearings, to individuals for whom specific long-term care services have been denied, reduced or terminated. DRI will Review and address any systemic issues in managed care to ensure the State’s compliance with state and federal Medicaid laws and the U.S. Supreme Court decision known as Olmstead. DRI will provide training and education to families of children under age 21 about their legal rights to treatment under EPSDT and how to advocate to protect their legal rights. DRI will provide legally based advocacy and representation to children in administrative appeals when they are denied their rights under the EPSDT provisions of the Medicaid Act by a managed care organization or the Iowa Department of Human Services.
1. Priority: Preventing disability-based discrimination in housing
2. Needs addressed: Individualswithdisabilitiesmayexperienceadenial ofequalaccesstopublichousingorencounteralandlordwho will notprovidea reasonableaccommodationorotherwise discriminate againstthemduetoadisability.Inaddition, onDRI’spublicsurvey, approximately70%ofthepeoplerespondingstatedthatDRIneedstofocusonstrategiestogetmoreaffordablehousingfor individualswith disabilities.
3. Description of activities: DRI will represent individuals with disabilities whose landlords are not providing them with reasonable modifications or accommodations; individuals with disabilities who have been or about to be evicted based on their disabilities, and individuals who are encountering housing discrimination because of their disability.
Prisons and Jails
1. Priority: Protect the rights of incarcerated Iowans
2. Needs addressed: Individualswithdisabilitiesareoverrepresented in thecriminaljusticesystem.Onceincarceratedtheseindividualsare vulnerabletoabuse andneglect,suchasexcessiveusesofforce,denialofaccesstonecessarytreatment,orhousing in long-term segregation. Inmates with disabilities who are incarcerated should not suffer harsher conditions of incarceration simply as a result of their disabilities. The Americans with Disabilities Act embodies a national policy of nondiscrimination against individuals with disabilities and applies to prisons and jails, requiring that qualified inmates with disabilities be afforded reasonable accommodations and modifications to policies and procedures.
3. Description of activities: DRI will monitor at least two prisons to detect abuse, neglect, or systemic issues affecting inmates with disabilities. DRI will monitor at least five county jails to detect abuse, neglect, and ensure appropriate suicide prevention measures are in place. DRI will investigate, provide individual advocacy, or provide other appropriate assistance including representation or systemic advocacy to prevent or end abuse and neglect of prisoners. DRI will. Conduct individual investigations into suspicious deaths in prisons and county jails. Provide technical assistance in self-advocacy, short-term assistance, or information and referral to prisoners seeking initial or new accommodations/modifications to policy in correctional settings. DRI will provide individual advocacy to obtain accommodations for inmates denied access to prison programs and services as a result of physical inaccessibility or denial of reasonable accommodations such as assistive devices. DRI will conduct systemic activities such as evaluations, advocacy, recommendations, and technical assistance to ensure compliance with the Americans with Disabilities Act for incarcerated individuals who are Deaf, hard of hearing, visually impaired, or have mental illness.
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.
A. Sources of Funds received and expended:
Department of Education
2017-18 Grant Award
2016-2017 Carryover Grant Funds
Total Sources of Funds
B. Budget for the fiscal year covered by this report:
C. Description of PAIR staff:
D. DRI staff sit on the following groups and advisory boards:
Elder Law Section of Iowa State Bar Association
Family and Juvenile Law Section of Iowa State Bar Association
Probate Law Section of Iowa State Bar Association
Supreme Court Guardianship/Conservatorship Reform Task Force
Facility Crisis and Closure Team
Iowa Department of Education Special Education Advisory Panel
Section 8 Advantage Program Coordinating Committee
Disability Employment Initiative Leadership Team
Transportation Advisory Group
Society of Human Resource Managers (SHRM)
Association of People Supporting Employment First member
Region Two Youth Standing Committee
Iowa APSE board member
Coordinated Community Response team
Governor’s Commission on Persons with Disabilities
Mental Health Conference Planning Committee
Iowa Coalition for Integrated Employment
E. DRI had four grievances filed in 2018. Grievance One was filed by an individual facing criminal charges and alleging he was not provided with an ASL interpreter during interrogation. DRI declined to represent him because he already had a criminal attorney for his ongoing criminal case.
Grievance Two was filed by an individual requesting representation for an unemployment benefits overpayment. DRI declined representation because it was not a disability related legal issue and therefore was outside our priorities.
Grievance three was filed by an individual who was seeking representation to investigate alleged euthanasia of her mother and representation in a damage action against a nursing facility and the hospital where she died. DRI declined representation due to the request being for a personal injury lawsuit, which is outside our priorities.
Grievance four was filed by an inmate at a Florida correctional facility requesting representation related to alleged misconduct or retaliation he experienced. The individual’s request was not clear what services he was requesting, and DRI declined representation due to the fact that he is not an Iowa resident.
F. DRI has a good working relationship with the Long Term Care Ombudsman office. We have worked closely this year with the Managed Care Ombudsman which is located in the LTCO’s office, to collaborate, refer cases, and exchange information on the difficulties Medicaid members are having under managed care. We have also received some referrals for institutional issues from LTCO, since the staff in that office can no longer travel due to state government budget cuts. DRI and the Client Assistance Project have worked together in the past and we meet quarterly to coordinate services and continue to refer cases to one another as appropriate. DRI and CAP are both members of the Iowa Coalition for Integrated Employment.
|Signed By||Cynthia A. Miller|