Notes from MISCC Meeting
July 12, 2004


Jump Directly To... Data Committee Assessment Committee Transportation Committee QA/QI Committee Community Services Committee Presentation about the Nursing Facility Transition Grant Public Forums Public Comment Commentary
Present: Commissioner Maul (OMRDD), Paul Kietzman (OMRDD), Susan Peerless (MISCC staff), Mike Paris (SOFA), Greg Montegue (DOT), Greg Jones (OAPwD), Nancy Martinez (OCFS), Timothy Williams (OASAS), Karen Oates, Pat Fratangelo, John Allen (OMH), Bob Boehlert (CQC), Lisa Kagan (MISCC staff), Kathy Kuhmerker (DOH), Constance Laymon, Kim Hill, Lorrie Pizzola (DHCR), Henry Sloma (via phone), Harvey Rosenthal, Kathy Bunnell

Minutes from the last meeting were adopted.

Commissioner Maul reminded the MISCC that the public hearings begin this week in New York City. He urged MISCC members to be at the presentations. Pat F. questioned how people were being notified of the hearings. Commissioner Maul stated that state agencies sent out letters. The media has received an advisory about the forums in accordance with the Open Meeting Law.


Reports from Committees

Data Committee
John Allen from OMH reported on behalf of the Data Committee. He stated that the Data Committee has collected data from almost all of the state agencies on the MISCC that operate institutions. The Committee is now looking at additional agencies which provide community services but don't operate institutions. The Committee is currently working on the process to identify waiting lists and the amount of time it takes to get services.

Kathy Kuhmerker advised that the Community Services Committee has collected a ton of information on community based services. She'll share with the Data Committee.

John advised that the Committee will have a draft report for the full MISCC by the next meeting. Each state agency has developed a trend line to look at for institutional care and community services. The Committee will get the MISCC samples before the next meeting.

Commissioner Maul stated that he cautions the overuse of data. Data gives you multi year approaches, but numbers are not the answer. For example, in NY Cares, OMRDD has a lot of people on the program, but OMRDD also instituted customer satisfaction surveys.

Harvey asked about addressing unmet needs and making recommendations from the data. Commissioner Maul notes that OMRDD put people in nursing homes on the waiting list for NY Cares, but weren't successful in getting them out. When OMRDD used Self-Advocates they were much more successful. John noted that the Committee is collecting data around people in institutions who could be served in the community; it is not the same as they want to be served. Kathy Kuhmerker noted that at the Community Services Committee meeting, they talked about this being a culture change. What we thought was fine 15 years ago is no longer state of the art. Things will change over time. Henry Sloma noted that MISCC needs to develop baselines. John advised that the Committee went back and looked at several years to find out if we're doing good things on the institutional side and the community side. Commissioner Maul advised that his personal bias is not numbers, but customer satisfaction. Harvey stated that in mental health, it'd be useful to know how many people who are in state facilities and Adult Homes could live in the community if services and supports were available. Commissioner Maul stated that the MISCC may be recommending how to identify need and do outreach as part of the baseline. He also stated that the MISCC needs to look at customer satisfaction surveys.

Assessment Committee
Lisa Kagan reported. She noted that the Committee has added members and has met twice. They first collected assessment instruments and now have gone back and looked at how each state agency assesses people who want to move to a more integrated setting. She noted that it is not just tools. The Committee has an inventory of best practices.

OMRDD:   HCBS Waiver (ICF level of care) Real Choice Grant-Self Advocates in ICFs Self-Determination Project
       DOH:   Nursing Facility Transition Initiative Discharge Planning Workgroup Waivers: CAH, TBI, LTHHCP (Institutional level of care)
   OASAS:   Looks throughout the system
      SOFA:   Ombudsman Program Point of Entry
      OCFS:   CCSI
      OMH:   Vision and mission Coalition to promote community based care Single point of access Family education
       CQC:    Protection and Advocacy

Lisa advised that the next step is to nurture excellent pilots and see where we need to fix things. The Committee is going to develop best practices in assessments.
Pat F. advised that we talk about integration and institutions, but people have different definitions. The vast number of people are people who aren't getting excellent services. We need to talk to people in real language about what they really want. If we're not careful, we're going to try to support our current system by saying it does good things.

Commissioner Maul noted that best practices are great, but there's a formula for making change. You need to find out what motivates the provider (i.e. money). You have to get the provider to buy into the change so that the provider doesn't fight it.

Harvey advised that the Committee discussed that the assessment process currently has a bias because of the lack of options. Commissioner Maul stated that you can say it's a bias, but it's more of a mindset. You have to sit down and brainstorm about what you can do. It's also about risk assessment. Pat F. commented that it's about risk on many level. You need to discuss what safeguards can be put in place. You have to think about all the risks. Commissioner Maul said that we should take the best practices and dissect them to find out how they became best practices. Kathy K. commented that the MISCC should provide a framework that all people working in the field can work from. Karen advised that we need to have local entities collect 10 things and could serve as a report card. She suggests that Commissioner Maul writes up his successes for changing the system and shares it with other state agencies.

Transportation Committee
Greg Montague reported. They have met twice since the last MISCC meeting. They went over the mission statement which deals with local non-profits and best practices. They surveyed MISCC agencies about transportation programs (environmental scan). They got best practices from Schoharie County Public Transportation, NRCIL and Medicaid Motor Services of Rochester. The Committee will document those best practices. They talked about coordinating transportation. They are now thinking about expanding our mission to look at Transportation Authorities and having DOT look at the evaluation of applications for the 5310 program. The Committee thinks that coordination of transportation should be a more heavily weighted criteria. An issue that the Committee is running into is "what motivates the provider?" Harvey noted that ARC runs the biggest segregated transportation program on the local level. Pat F. commented that it is good that the Committee is looking at public transportation.

QA/QI Committee
Mike Paris reported. The Committee has selected a set of QA tools for analysis. The Committee is identifying gaps/weaknesses and identifying strengths and unique data elements. The Committee has asked the members for a written analysis of by July 30th. CQC, DOH and ADAPT have done presentations. Issues discussed have been reliability, cultural sensitivity, safety, abuse and follow-up and service system coordination. The Committee invites comments from other MISCC members. Commissioner Maul advised that the MISCC needs to discuss how to make this a usable document and accessible to the public. Each Committee should think about this. Harvey noted that he was very impressed with CQC's analysis of the tools. It would be great if, as part of the MISCC process, the agencies take their recommendations into consideration and improve their QA tools.

Community Services Committee
Kathy Kuhmerker reported. They have 11 members and have met twice since the last MISCC meeting. They asked each MISCC agency to provide information on the programs that they operate. An observation is that it is a daunting list and there are a wealth of services being provided in New York State. The Committee noted the following observations:
     · Negotiating various sources of information is difficult
     · We need better services but not more services
     · Most people seek information in times of crisis
     · We're talking about medical and non-medical services
     · We need principles and guidelines
     · The system should be person centered, include self-determination, user-friendly, affordable and efficient, meet consumer needs and appropriate balance between medical and non-medical services.

The Committee has drafted recommendations for the MISCC and the MISCC should develop a vision. This is a major culture change. It must be a constant, evolutionary process. Information needs to be locally based and user friendly.

Commissioner Maul noted that in the public forums, the MISCC will hear a lot in terms of that vision.

Presentation about the Nursing Facility Transition Grant
Nick Rose from DDPC gave a presentation about the Nursing Facility Transition Grant. The grant is a collaboration between SOFA, DOH, DDPC and SED. 6 Independent Living Centers were awarded grants during the first year. 5 of the projects were continued in Year 2. All project participants and state agency partners meet every 6-8 weeks. The partners found that the number one barrier to living in the community is the lack of affordable, accessible housing. Other barriers include approval for DME, co-existing disabilities, transportation and timely assessments and service approvals for community supports. So far, 66 people have transitioned from nursing homes, 166 have been identified and assessed for transition, 73 people have been diverted from nursing facility placement and 720 have been trained in the transition/diversion process.

Kathy Kuhmerker noted that there has been a change in the nursing home culture. There are more rehab beds and a smaller amount of long-term care beds. Length of stay has plummeted. There is more interest in having people not stay in a nursing home on a long-term basis.
Nick noted that there are 2 levels of assessment---liberty assessment and coverage assessment. This is in the Kaiser report on Olmstead.
Commissioner Maul stated that we need to look at some of the ways that people are brought forth to assist people in transitioning. He said that it works best when it is someone you know, for example, a friend who is assisting you. He questioned if it was paid staff doing the transitioning or volunteers. Mike Paris advised that he will provide a description of the Ombudsman program, which is a volunteer program. Henry Sloma noted that the new bed need methodology shows not new bed need.

Commissioner Maul asked Bruce Darling to share nursing facility transition training that he has done with the Community Services Committee. Bruce will send the link to Kathy Kuhmerker. Bruce also noted that it is not volunteers doing the transition work; it is paid staff. He asked Commissioner Maul if he'd be willing to get rid of the OMRDD Service Coordinators and have volunteers do that function.

Harvey asked for a report from the Interagency Housing Group. Commissioner Maul said he'd look into this.

Public Forums
Commissioner Maul noted that the MISCC is going to try to make people feel as at home as possible. Kim expressed concern that there won't be a stenographer at the public forums. Commissioner Maul said that people will submit testimony and that people become intimidated when there's a stenographer. Henry Sloma said that at stenographer should be there. We need accuracy and people will want to feel valued. Pat F. suggested that the MISCC could offer the option. Another option would be to tape it and transcribe it later on. Commissioner Maul said that if a stenographer or tape recorder were used, people should still have the option of providing unrecorded testimony.

Public Comment
Bruce Darling noted that there are guidance about assessments. He also noted that cuts in staff at the county level have delayed assessments for services. Bruce suggested that the MISCC should have a Housing Committee. The Interagency Housing Group is a closed process.

Chris Hilderbrant reminded Commissioner Maul that at the last meeting, he promised a response to the suggestion that a Housing Committee be created. Commissioner Maul said that housing is very important, but he has no response. Chris also pointed out that for the public forums, some people can't bring written testimony. He also pointed out that not everyone will register, but they should still be allowed to speak. Chris advised that the DOT just held meetings in Rochester about their master plan. The MISCC Transportation Committee should meet with the DOT Advisory Council. Chris also re-iterated that a paid position is a must for nursing facility transition work.

The next MISCC meeting is scheduled for September 20th.

Commentary
NYS ADAPT is extremely concerned that Commissioner Maul feels that Nursing Facility Transition work can and should be done by volunteers. People that assist seniors and people with disabilities in getting out of institutions are basically service coordinators. As such, they must be skilled in policies that affect services and supports, aware of all community-based services and supports and good at advocating. The people doing this work also need a great deal of technical information on a wide range of disabilities unlike the TBI and OMRDD waivers which have populations more restricted by diagnosis. Nursing Facility Transition can be more successful if it built on a peer-based model, such as those utilized by Independent Living Centers.

Additionally ADAPT is concerned about that stenographers will not be made available at the public forums. All testimony must be recorded accurately. The MISCC is charged with developing a plan to implement the Olmstead decision in New York State. This is a big charge and any and all public input must be recorded. Relying on people to submit testimony is not enough as some people cannot provide written testimony.

The MISCC seems intent on developing principles and guidelines instead of developing a plan. Furthermore, the MISCC is inventorying best practices without asking advocates for their comment or asking what is not working in the system.


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