|
|
|
|
|
Data Committee We did not arrive in time for the Data Committee meeting. QA/QI Committee Meeting Present: Pat Fratangelo, Lisa Kagan, Susan Peerless, Neal Lane, Greg Jones, Sharon Flom, Harvey Rosenthal, Gary O'Brien I-Hsin Wu from SOFA gave a presentation on the QA tools that Neal sent out to the Committee members. Some of the committee members did not receive the tools; Neal will re-send. I-Hsin gave the following analysis: Gaps/Weaknesses of existing tools · Most consumer satisfaction tools don't include outcome indicators · Most tools are designed to evaluate a specific program and for a specific population · Most tools don't include questions addressing quality of life · Most tools don't contain a sufficient number of open-ended questions · Most tools don't specify whether a proxy is allowed to respond to the questionnaire on behalf of the consumer · Most tools don't specify whether a culturally diverse disabled population can use the tool By "outcome indicator", I-Hsin means that we want to measure the end result of what we want to achieve through this program. Harvey noted that too often tools measure things like food and personality of the staff instead of outcome indicators. Neal advised that focusing on outcome and what is possible for the customer is important for systems change. Strengths in existing tools · Evaluate services from the consumer's point of view · User-friendly · Some include outcome indicators. They assess the quality of life · Offer consumer opportunities to identify problems and make suggestions to better services · Assess services comprehensively. Assess how services are delivered and whether the consumer is satisfied with the service · Consumer can make comments in their own words (contain open-ended questions) · Valid and reliable Unique data elements Depend on the disabled population for whom the tool was designed, but there are general data elements. · Access to care · Safety issue · Competency of service providers · Inter-personal relationship · Consumer treated with respect and dignity · Choice and control · Evaluate the service system · Service impact (outcome) · Community integration · Suggestions Cultural diversity should be factored into the tool. You may also want to include employment for the younger disabled population. Harvey questioned if cost of the service should also be a unique data element. I-Hsin advised that she would include cost as an essential data element. I-Hsin noted that there are three ways of collecting data: · Consumer · Proxy · Program Administrator I-Hsin looked at 20 tools. Several issues emerged from her analysis: · Need to define quality from the consumer perspective (may be different from provider) · Need to address quality issues for all disabled populations · Need to include input from consumers and other stakeholders · Need to identify principles and guidelines on how each disabled group should be evaluated · Identify quality assurance and improvement strategies · Set benchmarks (expectations about functional improvement) · Monitoring process of consumer's experiences · Incorporate remedy procedure · Must be a continuous improvement process which includes data from surveys and complaints from the consumer Harvey questioned if we should also be measuring coordination of services and continuity. I-Hsin advised that this is part of the general areas. Pat advised that the Committee should brainstorm about what is important in people's lives. There is a danger in doing this if we are not prepared to make changes. Harvey questioned how the Committee's work will help improve New York's policy around community integration? Neal noted that this is no small job. We need core questions that shoot across all of our evaluation tools. The committee should identify principles and guidelines on these issues and an evaluation of each disability group. The Committee may want to suggest that the works needs to go beyond that. It may be an ongoing workgroup. Neal advised that the Committee can issue principles that must be in all tools. Community advocates can then evaluate the tools in that light. Bruce Darling and Tracie Crandell were invited to address the Committee. Bruce and Tracie advised that they agreed with much of what I-Hsin had expressed. Bruce pointed out that a major problem is that the definition of abuse is different in each agency. Tracie and Bruce also stressed that there needs to be a full wrap around evaluation and that consumer satisfaction surveys aren't enough. Not only should there be a qualitative assessment, there must also be a series of quantitative measures. Agencies should be able to discern trends from the qualitative and quantitative evaluations in order to improve the system. Pat noted that we need a standard definition of institution and of integration. Institution is not just the building; it is a mindset. It is about inclusive lifestyles. Neal noted that the technical experts are asking for an evaluation at the customer level, the agency level, trending outcomes and clear definitions/standard language. Neal advised that he will send out I-Hsin's analysis to the Committee and sent out the evaluation tools to people who didn't receive them. Neal advised to write up your comments on the evaluation tools and get them to Susan by June 25th. Susan will send to the group by June 29th. Committee agreed to have the technical experts continue to present at the meetings. The next meeting is scheduled for July 1, 2004. Transportation Committee Present: Greg M., Susan P., Mike P., Harvey R., Lisa K., Greg J., and Henry S. (via phone) Greg invited Henry Sloma to introduce himself. Invited speakers gave presentations about transportation programs. The first speaker was Pat Cooper from Schoharie County Public Transportation. Ethel from Schoharie County also participated in the presentation. Pat handed out a booklet that detailed the history of public transportation in Schoharie County. Currently Schoharie Co. has 11 vehicles and 8 routes. They have two commuter runs that go into Albany. The current budget is around $800,000. Some of the funding comes from fares, some from STOA assistance, some from county taxpayers, some from contracts (i.e. with DSS) and some from 5311 Funding. There is a noted inefficiency in the program. For example, individuals attending a Mental Health Day program take the day program van, even though public transportation goes the same way. The office of mental health says it's because they have a van and if they don't use it they will lose it. The next group of speakers detailed a transportation program that is operating in the North Country. Don Drew of the Volunteer Center of Jefferson County handed out a chart to committee members. This program uses volunteer drivers who are reimbursed for their mileage. The program serves seniors, people who are blind, persons who have developmental disabilities and other persons with disabilities. Don noted that requests for this service are "going through the roof". The Volunteer Center has a limited budget. They have not denied any requests so far, but they have restricted services. When wheelchair transportation is needed, they coordinate with NRCIL. Don noted that the program doesn't qualify for 5310 or 5311 monies because they use volunteers. After the presentations, Tracie Crandell, a member of the audience asked the chair if the Committee would be dealing with public transportation, i.e. transportation authorities. Greg M. advised that due to time constraints, they would only be dealing with Human Service agencies. Harvey reminded the Committee that this is only the first cut and we were supposed to deal with public transportation later. Greg M. advised that the Committee will have to decide later if they have the time to deal with public transit. The next meeting is on July 1st. Community Services Committee Present: Kathy Kuhmerker, Constance Laymon, Lorrie Pizzola, Michael Parker, Susan Peerless, Lisa Kagan, representative from OASAS, Doug (SED), Harvey Rosenthal, Carol Raphael, Kathy Bunnell from Broome Co. OFA (phone). CQC, SED, OCFS, DOH, DHCR, and OASAS responded to the Committee's request for information. The Committee needs to have a status report into the full MISCC by July 12th. Feedback on what was received from agencies Lorrie noticed that the question about funding cycle is missing. This is not an issue for OMRDD or Medicaid. Constance said that looking at all the submissions gave her a headache. Carol commented that we seem to have a lot of different programs out there, but from the commentary given at the MISCC meetings, there still seems to be an institutional bias. This needs to be reconciled. Kathy advised that the charge of the committee and the Council is to get a sense of what services are available to keep people in their own homes and to look at the gaps. Kathy also reminded the Committee that we still have the Point of Entry proposal. Kathy suggested that as a recommendation, we could say that there may be different ways to get information on services to people. A possible question for the public forums is "What are the successful ways you have gotten information?" Harvey advised that he is trying to figure out where we are going. We're collecting data that will tell us three things: · What government funded services are out there · What gaps are out there · How do you know services exist Kathy advised that as a state agency representative, she'd have a difficult time telling other state agencies how to fix the gaps. She said that she thinks the Governor's Healthcare Reform Working Group serves that purpose. The Committee should set forth principles and guidelines. They are different than "fixing" things. Lisa suggested that we look at the things we offer from the point of view of who needs the services. We need to organize the information in a way that is user friendly. Lorrie pointed out that we must build more housing so that people can live in the most integrated setting. Kathy K. advised that she likes the idea of principle and guidelines. Kathy Bunnell advised that she will get the Committee information on elder-friendly communities. Kathy K. advised that so much of what lets a person stay in his or her own home is having a caregiver. Lisa advised that an important principle is having service coordinators who know all of the services and how to access them. It is also important to have updated information and information that can be accessed via the Internet. Lorrie questioned what the Committee's goal is. Harvey suggested that the Committee make recommendations to address the gaps, and develop principles and guidelines. He pointed out that it's not just about identifying gaps, but that we also need findings and recommendations. Kathy K. advised that she agrees, but she is not sure that they are equipped to do that. Carol commented that at the public forums, the Committee should ask how we can best get information to people; this is more important than hearing about one person's gaps. Lisa suggested that the Committee ask questions about what is successful. Carol said that the Committee should also find out about eligibility issues. Some questions that the Committee may want to ask are, "What is your experience in getting your needs met in your community?" "What has or has not worked in your community?" What is the best way to get information out to your community?" Kathy noted that DOH has the Real Choice Systems Change Grants out and the Nursing Facility Transition Starter Grants out. Kathy also questioned how we account for public and private agency activities. She said that there needs to be some sort of recommendation made for people who won't qualify for Medicaid. They still need early information about services. Carol agreed that giving information at a non-crisis point is very important. Kathy advised that she will draft the status report and send the draft to the Committee by July 1st for review. Assessment Committee Present: Lisa Kagan, Susan Peerless, Constance Laymon, Harvey Rosenthal, Michael Parker, Pat Fratangelo, Nancy (OCFS) Review of Statute: Michael Parker commented that it is different than eligibility determinations. Nancy discussed the OCFS assessment tools that were submitted to the Committee for review. She advised that the OCFS Commissioner thinks it is best to serve kids in the context of their families. The Committee should ask Doug Bailey (SED) the principles of the Coordinated Children's Services Initiative (CCSI). This is a multi-agency initiative. Uniform Set of Principles: Michael Parker advised that we should ask people where they want to live and what they want from their lives. Lisa K. noted that each program gave the Committee their own eligibility tools, but the Committee is not going to be studying all the eligibility tools. Donna (Counsel for OMRDD) suggested that the Committee looks at one assessment tool for people that are institutionalized and another for people that are in the community. Harvey questioned how you identify an institution. Constance noted that it is also about choices. Lisa suggested that the Committee recommends the principle that people should be told about their options. Donna advised that the Committee should identify current assessment procedures, i.e. What does OMRDD use now to assess a person's needs, desires and wants? Then the Committee should discuss what works best for each agency. There was a major discussion of the MIS Law and what the Law calls for. Bruce Darling (audience member) pointed out that the MIS Law calls for an assessment tool to identify people who want to live in the Most Integrated Setting. It should not be used for eligibility determination. Tracie Crandell (audience member) advised that this assessment to identify people must be done independently of what services actually exist. Bruce pointed out that the MDS could be used for this purpose. Tracie advised that many of the agencies might not have formal tools that they currently use to identify people who want to live in the most integrated setting. Tracie suggested that when the Committee sends another email to the state agencies, they might not want to use the word "assessment" because it is confused with eligibility determination. The Committee may just want to ask each agency, "How do you identify people that want to live in the most integrated setting?" Lisa advised that the Committee needs to re-frame what we're asking state agencies. It is not necessarily an assessment that is done upon admission to the institution; it is a re-evaluation. It is about making sure that people remain in the most integrated setting and developing a tool for people in segregated settings who want to move to a more integrated setting. A best practice could be determined by finding out about how people know their options and both the initial assessment and at re-evaluation. Commentary It seems as if the Committee chairs got together before the meetings and decided that they were only going to develop "principles and guidelines". Based on this shift, NYS ADAPT is very concerned that the MISCC is not going to make any substantial recommendations that will result in real systems change, even though that was the purpose of the MISCC and it is supposed to do so. In addition, it appears that the Chair of the Community Services committee is relying on the proposals of the Governor' Healthcare Reform Working Group to "fix" the long term care system, as she says that it is not the MISCC's place to direct state agencies on how to better the services that they provide. The MISCC still has the potential to make lasting systems change so that individuals of all ages with disabilities can live in the most integrated setting. However, they must be prepared to seriously examine the flaws in the long-term care system and make substantial recommendations for improvement. |