If you missed the January 20th meeting, here are the updates
OPTIONS FAMILY, STAFF AND ALLIES MEETING
January 20th, 2010
PURPOSE OF THE MEETING
• To clarify the current situation
• To provide information about the current situation
• To encourage action
• To promote the creation of a new coalition of families
• To be proactive about the cuts
• To request a systems audit related to the PDD budget
AGENDA
• Welcome and Introductions
• Background information
• Overview of new PDD directions – Supports Intensity Scale
• The current crisis
• Questions
• Focused Action
• Next Steps – Coalition?
Community Inclusion Supports Framework
Based on the following principles:
• Dignity and equal worth
• Having control and choice
• Participation in the community
• Valued Staff
• Responsive system
• Openness
• Equity, effective stewardship and accountability
SCOPE OF THE CURRENT FRAMEWORK:
• Supports are best identified by getting to know individuals over time;
• Supports must confirm the roles chosen by individuals
• Supports must focus on building and strengthening the individuals connections to natural supports; and
• Supports must focus on building capacity in the community
MINISTER’S DIRECTIONS and OBJECTIVES
• To clarify the program’s mandate
• To improve consistency in the delivery of the program
• To enhance effectiveness (outcomes)
• To increase efficiency
• To ensure program sustainability
MINISTER: EXPENSES EXPLODING!
• Minister states the average cost per person is $61,000 per year (without other health costs)
• Inequity of resources
• Numerous individuals receiving “Cadillac” services or more who have no medical support needs, no behavior support needs, and supports for daily living
• Countless persons with extensive needs in one or more areas with seeming adequate resources costing far less
• Growth in need
• Individuals being supported by more than one agency
GETTING ALLOCATIONS RIGHT?
• Do we really know what it costs to serve a person?
• Why are some people allocated more than others, even though they have similar needs?
• Is the allocation of funds fair? Is it based on support needs?
• Is this efficient?
• Need to assess needs systematically and allocate accordingly
SIX PRIORITY AREAS FOR ACTION
• Introduce a regulation to clearly define who is eligible for supports from the PDD program
• Provide clarity on the program’s mission and core businesses
• Developing a consistent approach to determining individual support needs and the related funding to ensure fair and equitable treatment of people receiving supports
• Increasing flexibility for families to manage
• supports for their family members
• Improving supports for individuals with
• developmental disabilities who have complex needs
• Increasing the effectiveness and efficiency of the PDD program, both internally and in the community service delivery system
STRATEGY #3: Develop a Common Approach to Assessment of Individual Support Needs and Related Funding
SUPPORTS INTENSITY SCALE
• What prompted the introduction of this tool?
• Development of the model.
• Key components
• Implementation
• Next steps
• Questions??
SIS - HISTORY
• Currently being used in 17 countries
• Translated into 13 languages
• Now on-line so scoring data and reports is quicker
• Alberta now has 20 certified interviewers across the province and 5 “master trainers”
• Key Components - SUPPORTS INTENSITY SCALE
• Developed by the American Association of Intellectual and Developmental Disabilities (AAIDD) over a 5 year period in response to changes in how society views and relates to people with disabilities
• A standardized assessment tool, specifically designed to measure the pattern and intensity of supports an adult with developmental disabilities needs to be successful
• Measures the level of support required to “succeed”
Emphasis on natural/community supports- All non-paid support must be utilized prior to paid supports
IMPLEMENTATION
• As of November 1, 2009 all new eligible individuals will have a SIS interview
• Starting January all individuals currently receiving services will be interviewed. To be completed over the next 3 years
• Interviews taking 4-6 hours although striving for 2 ½ to 3
• Policy is being drafted
WHY IS THIS ATTRACTIVE?
• It is reported by those states using SIS there is significant savings
• Average cost in Louisiana anticipated being $44,208;
• Savings used to serve people waiting for services
• People will have increased independence and increased quality of life
• Stabilization of costs
• Cost Effectiveness
• Reduction in time waiting for services
• Increase in number served within our Current Resources
• Increased outcomes for people
QUESTIONS???
• What is the impact on individuals, agencies and the overall system?
• Is there an “exceptions protocol”
• What is the impact on the current service providing system?
• Is there a detailed implementation plan and can I have a copy?
• What are the resources required to implement? What has it cost so far?
• What are the personal and financial costs to the individuals and families (time?)
• Can I refuse to have it done?
• Can I appeal if I don’t agree?
• How do you see this enhancing my individual’s life?
• How will the funding resources be allocated?
• What will the “funding bands” be?
• What happens if needs change?
• Do you need Guardian consent to perform the interview/SIS?
• Who is covering the cost for agency staff to be involved?
• How are you going to ensure that the supports needed are provided?
• What happens if my current funding is too low? Can I expect to have additional funding allocated?
• If my needs are too high, will I be referred to a different department or institutionalized?
• If my IQ is over 70 but I am currently being funded through PDD will I lose my services
• If my needs are very high, will I be able to access one-to-one funding?
• How many levels of funding will there be?
• How often will needs be reviewed?
• Will there be a maximum number of hours of support?
• What models of support will be considered?
• Will the agency that currently supports me be able to receive the information from SIS?
• Who in PDD will review the information and assign the funding?
• What will be the timelines for decisions?
• Will there be an appeal process?
• What impact will there be on the PDD system i.e. Client Services?
THE CURRENT CRISIS
• Calgary Regional PDD Board provided formal confirmation of in-year contracted and retroactive funding reductions of approximately 2.1-2.3% of annual agency contract budgets. OPTIONS received notice on Dec. 11/09 with the expectation that plans for reductions would be submitted by Dec. 18th/09
• With the new PDD contracting model, funding is reimbursed AFTER services have been provided and invoiced.
• We have already delivered services for ¾ of the year. We are being asked to give money back that has already been spent.
• OPTIONS reduction $219,960.13
• Our response was that we expect our contract to be honored without “in-year adjustments” and we would not be submitting plans
WHAT WILL BE THE IMPACT FOR OPTIONS?
• Direct impact on our direct services
• Potential reduction of service hours
• Potential increase in staff/client ratios
• Potential impact on Day Program /Residential services and activities
• Reduction in flexibility to respond to needs (medical appointments, equipment repairs, etc)
WHAT HAVE OTHER AGENCIES DONE?
• Closed homes on weekends
• Introduced a Service Fee
• Reduced Supportive Roommate compensation
• Given notice to some individuals
• Laid off staff
LEGAL IMPLICATIONS
• Individual Service Agreements
• Notice to families
• Employment Standards (Notice to staff, reduction of wages and benefits)
• Administrative costs
• Fixed costs such as rent, equipment leases, etc
• Risk and liability issues
• Quality standards are in jeopardy
COMMUNITY RESPONSE
• Rally’s held in Edmonton and Calgary
• Media coverage
• Families and Service Providers interviewed
WHAT IS THE COMMUNITY RESPONSE?
• Edmonton service providers are taking a unified stand – no cuts & SIS put on hold
• Calgary service providers are divided and some have submitted plans
• Concerns about closure of some programs
• Accusations of “fear mongering”
• PDD rumored to “tender” programs
• Suggested significant cuts to budget April 1/2010
POLITICAL AGENDA
• Currently there is a mandate to provide services – Community Governance Act
• Possible risk of removing mandate?
• Rationing of services?
• Reduction of core service components?
• Increased expectation that families will be more involved?
• Rapid change to system; economic pressures outlined as reason
• Development of new PDD program policies
• Business relationship
• Procurement model
• Reduction of number of service agencies
Suggested reading
• Seniors and Community Supports Business Plan 2009-2012
• SIS information
• AACL information
HELPFUL ACTIONS
• Write the Premier and cc. the Minister. Outline your concerns, describe what services mean to you and include a picture of your son or daughter. Equate the cuts to your personal situation and the impact on you.
• Emphasize that it is impossible to make the cuts without reducing services
• Don’t accept non-specific responses
• Meet with your MLA with your individual if possible
• Unite with other parents to gather information, monitor, advise and provide input into the decisions that are being made.
RECOMMENDATIONS
• Be honest
• Be brief, clear and avoid acronyms
• Be yourself; your caring, values and commitment are powerful
• Stay in touch with other families/allies
• Keep OPTIONS informed
Ask questions as it relates to
• What are the health-related supports and services that will enhance independence and well-being? Are they different than they currently exist?
• What are the safeguards for people with disabilities?
• What is the targeted budget reduction in this area?
• What are the specific plans to maintain?
SKILLED, QUALIFIED STAFF?
• Will there be an evaluation of the impact/benefit of the changes?
• What are the planned reductions for 2010-2011?
• Will families be involved in evaluating process? The following are some websites of interest: