MISCC Full Council Meeting Minutes---October 14, 2004

Jump Directly To... Housing Discussion Agency Culture Change Nursing Home Transitions/Diversions Audience Input ADAPT Commentary

In attendance: Kim Hill, Harvey Rosenthal, Michael Parker, Kathy Kuhmerker (DOH), Greg Montague (DOT), Nancy Rodriguez (OCFS), Susan Peerless (DOH), Commissioner Maul (OMRDD), Lorrie Pizzola (DHCR), Lisa Kagan (OMRDD), Carol Raphael, Greg Jones (OFAPwD), Neal Lane (SOFA), John Allen (OMH), Pat Frantangelo, Gary O'Brien (CQC), Constance Laymon, Tim Williams (OASAS)

Commissioner Maul welcomed the group and outlined the agenda for the afternoon. The Commissioner asked for a review of the prior minutes and they were accepted by the Council as is. Commissioner Maul indicated that the committee reports were not ready for distribution at this point and would be ready in the next couple of days.

Housing Discussion
The first item on the agenda list was a housing report. Lorrie Pizzola from the Division of Housing and Community Renewal gave a report on what DHCR is doing. Lorrie discussed the establishment of the Governor's Inter-Agency Task Force, which began in September of 2003. The Task Force has come up with ideas for new opportunities in funding and the types of housing and supports pertaining to Olmstead implementation. During the meetings of this task force, they heard from representatives of the Community Reinvestment Act and how it can help with funding options, listened to a HUD overview, and heard from financial institutions. The Task Force is also working with the banking department on financial solutions.

The Task Force is looking at developing a policy inventory, where existing programs and policies would be made available through a directory. The Task Force also created a sub-committee on adult homes. This sub-committee helped two adult homes in Long Island stay open through tax credits and funding.

The banking department announced that it has received $4 million in grants from the federal government to provide low-income and supportive housing. The task force is encouraging $6 million for 2006. The Task Force is inviting DDPC to the next meeting to obtain suggestions on housing options and an assessment of the needs that are out there. Some updates on DHCR programs:

· The HOME program is giving 5 points to those developers who target applicants with special needs (this year about 15% received funding). For 2004, they are targeting 604 projects, which amount to about 24% of the awards granted for housing for those with special needs.

· NY Main Street program has about $20 million in awards. These funds are for downtown improvements. The money can also be used for providing accessibility to existing buildings.

· Unified Funding, which funds project-based Section 8, is working on improving marketing and developing guidelines so people get the housing who need the housing, and in general, create a public awareness.

Lorrie reviewed the requirements of Section 504. In DHCR's interpretation, Section 504's 5%/2% set-asides do not have to be built fully accessible, but can instead be built adaptable and later made accessible at the tenant's request and owner's expense.

Lorrie went on to discuss DHCR's proposed steps for 2005:

· Unified Funding for 2005-any project accepting state funds must make 5% of their housing adaptable to those with mobility impairments and 2 % for those with visual impairments (this is already mandated for projects receiving federal dollars). The landlord/owner will pay for adaptations, not the tenant.

· On the affordable housing registry, DHCR is working on adding search criteria to locate accessible housing funded through DHCR projects.

· Program and policy handbook-will streamline request for proposals/funding cycles for development companies.

Harvey Rosenthal interjected with a question asking if the interagency meetings were open to the public and if it would be possible to obtain a copy of the interagency task force meeting minutes regarding what they are doing. Lorrie indicated that the meetings were not open. Harvey also asked about the DHCR's definition of a special population and Lorrie responded it includes: the homeless, those with a mental health diagnosis, OMRDD, those with HIV/AIDS, the frail elderly and the elderly, those in foster care, domestic violence victims, and those with physical disabilities.

Carol Raphael reminded DHCR that they should be looking at these questions: What is the need? What is available? What is the unmet need? Carol also had a question regarding funding streams. Lorrie indicated that the banks get community reinvestment act money for funding low income/public housing projects.

Kim Hill read from a report from the Assembly Task Force regarding a public housing hearing held on 4/30/04, regarding the lack of accessible/affordable housing. Kim recommended that the MISCC read the CTIONY paper, "Home Sweet Home, unless you don't have a home".

Based on this report, Kim indicated some topics of most importance:

1. Limited incomes-there is often discrimination to those who pay rent with SSI/SSD or a subsidy as the method of payment

2. There is no centralized statewide registry

3. Section 504-the 5% and 2 % regulation lacks enforcement

4. Private homes are not visitable

Kim did note however that some steps have been taken to solve these issues. The MISCC was formed, the Medicaid waiver is in front of the Governor, legislation in the Assembly to extend SCRIE to those with disabilities, housing waiting lists established in the MH community, the Long Island Work Force Housing incentive program, where 10% of new projects have to be accessible, has been extended, and the state investment in affordable multi-family housing. Kim indicated that the state still needs to work to end income source discrimination, mandate an accessible housing registry, enforce Section 504 of the Rehab Act, and establish a housing trust fund.

Kim stated that the MISCC needs to be extended past the final report and keep working together in the future.

Commissioner Maul interjected that the OMRDD has a housing registry (NYS-CARES) and other agencies have similar lists.

Lorrie Pizzola indicated that the MASS Access program in Massachusetts has no enforcement authority, but that it is a positive tool.

Carol Raphael asked how the housing trust fund would be funded: through loans (how effective will this be) or through incentives. Kim referred the answer to Chris Hilderbrant who responded that the loans would be used towards making environmental modifications, home ownership programs similar to the OMRDD home ownership program, and rental subsidies. Chris also noted that visitability should be enforced statewide and it should be the basic visitability: one no-step entrance, wide doorways, and one usable bathroom on the first floor. Chris also brought mention that in NY, Section 504 is enforced as adaptable, instead of accessible.

Kathy Kuhmerker asked if there were available standards as a part of visitability and if so, this info should be sent out to builders and home improvement stores.

Chris responded that the building codes area is a problem and that we need to raise access on the radar. Code inspectors and enforcers need to be better versed in accessibility and related requirements.

Greg Jones also responded to the building codes question and indicated the international building code has been adopted to maintain requirements that every unit in buildings with elevators be built as 'adaptable' units.

Lorrie Pizzola then proceeded to explain the DHCR definition of accessibility as per Section 504-which essentially is adaptability, meaning the space can become accessible with modifications.

ADAPT member, Shirley Bain, interjected that she was frustrated with all the talk that people in Albany do, but never take any action. Despite previously enforcing rules against public participation during the MISCC meeting, Ms. Bain was allowed to continue to speak. Shirley pointed out that the Governor needed to sign the Nursing Facility Transition and Diversion Medicaid Waiver into Law and that the MISCC needed to be taking action instead of talking about action. Shirley is 77 and has Cerebral Palsy.

Kathy Kuhmerker indicated that as she had been traveling, she has noticed that more hotels have been accessible. Greg Jones responded that initially this was due to code and regulatory requirements, but has also become a marketing tool as the population is aging.

Agency Culture Change
Commissioner Maul then moved the meeting on to discuss the state agency cultures. He asked for the reports from the previous MISCC meeting regarding how each agency could improve its efforts related to Olmstead.

Gary O'Brien from the CQC went first. He discussed the Surrogate Decision Making Committees, where four members decide on non-emergency medical treatment for a consumer. The CQC offers technical assistance and training. He also noted that eight federal grants were sub-contracted which disseminated information to consumers in the most integrated setting possible. CQC also established a family resource network collaboratively with VESID and DDPC.

Lisa Kagan from the OMRDD went next. She discussed how OMRDD assesses each new consumer as they enter the system regarding the level of consumer satisfaction. She also indicated that additionally OMRDD management recently had a retreat with self-advocates, self-advocates train all MSC's, and self-advocates and parents train program recipients on their rights.

Another new program is the NYS OPS program which addresses what is needed and then individualizes the services, for example: jobs, transportation, consumer-controlled housing, larger to smaller certified residences, more services to seniors with DD, the self-determination project, and the real choice grants. Commissioner Maul also added that a Speakers Bureau was created, training those to do public speaking and giving opportunities for public speaking.

The next agency to share cultural change information was John Allen from the Office of Mental Health. He indicated that OMH was aggressively doing quality improvement, adding recovery-oriented service to key areas of improvement. In the 2000 strategic plan, the goal was to promote quality mental health services to all New Yorkers. Evidence-based practice is being discussed in a meeting with stakeholders to determine if there are effective results based on A-accountability for both the programs and individuals; B-best practices; and C-coordination of care (so those do not fall through the cracks). John offered the Winds of Change program as an example.

Commissioner Maul, in the interest of time, shut down the culture change dialogue of agencies and indicated that those who choose to can report at the next full council meeting. He went on to introduce the next section of the agenda, actually doing nursing home transitions as a council, and indicated that he wanted to use the names of people who want out to see how the agencies work together to get them out.

Nursing Home Transitions/Diversions
Pat Frantangelo reported on this topic. She indicated that 11 people have been referred, 2 of those already had strategies in place, 5 were in nursing homes and want out, and 3 want to be kept out. Pat introduced them to the council and gave a brief bio of each. In her analysis, some of them clearly cannot get the services, some had the services and lost them or some of the services were inadequate. Most of these individuals are from upstate. Pat would like many different people of different ages with varying issues from different parts of the state. She hopes this exercise will develop services for other people.

Kathy Kuhmerker indicated that DOH is already working with 5 ILC's in the state with a group regarding transitions as a part of a real choice systems grant.

Nancy Rodriguez from the Office of Children and Family Services indicated that she could add some children's names for use in this project.

Constance Laymon indicated that it is great the MISCC is assisting with the process to live through it and obtain a better understanding.

Commissioner Maul assigned Lisa Kagan to put together a report on the people, the process, ways to observe, and ways to publish solutions.

Constance interjected that she wrote a letter to the Governor regarding the signing of the Nursing Facility Transition and Diversion Medicaid Waiver legislation and would be willing to share the template with anyone on the council who would like to use it.

Harvey suggested that the council meet in a different room next time. He also would like to obtain copies of the reports and asked the Commissioner when he would return to the field. Harvey also thought the MISCC has established some very good principles and the MISCC should continue to make sure they are implemented.

Carol Raphael then had a question regarding the Federal Grants that were awarded to 31 states from the CMS regarding affordable housing and did we apply for any of them.

The meeting was then opened for audience questions.

Audience Input
Shirley Bain indicated Albany bureaucracy is annoying. She indicated her frustration with the state saying they will do things and then nothing getting done.

Barbara Knowlen indicated that there are problems with nursing home transitions, specifically with the DOH. Medicaid is stopped if someone does not accept a nursing home placement. This is an obstacle that needs to be overcome before they can leave. Kathy Kuhmerker responded, indicating that the discharge planning discussions that the DOH has been hosting will be looking at the issues that Barbara raised.

Bruce Darling discussed the need for policies to be changed to turn around the institutional bias in NYS. Bruce indicated that while OMRDD has made significant progress in shifting funding toward community services, the rest of the long-term care system is still seriously biased with $2 out of every $3 spent on nursing home care versus the money spent on community services. Bruce indicated that CTIONY published a good paper; the MISCC needs to look at the recommendations to address these issues. The advocacy community will be watching the MISCC and reporting on the successes and failures.

Harvey Rosenthal agreed with Bruce. We need to have actual policies in place.

Sim Goldman spoke regarding the set up of the room. For the next MISCC, the room needs to have microphones and FM loops. The MISCC has to move along and not confuse process and planning with accomplishment. Sim also spoke about the Federal proposals to cut Section 8 tenant-based housing and how this will hurt people, something needs to be done.

Chris Hilderbrant suggested that polling the nursing homes, developmental centers and adult homes would be one means for the MISCC to identify a wide demographic population to work on transitioning people out. Commissioner Maul interjected that this is a good idea so we can have a sample from the urban and rural communities. Harvey was concerned that many adult homes might report that no one wants out. Chris added that that would probably be an indicator of an adult home that is not abiding by Olmstead or the most integrated setting mandate of the ADA.

The meeting was closed. The next full council meeting is scheduled for October 28th, 2004.

ADAPT Commentary
Though it has taken many months of pushing by the advocates, the MISCC finally focused some efforts on housing. Unfortunately, but true to form, the MISCC is just listening to what is already being done by the governor's office and agreeing that those are things that need to be done. The MISCC should have it's own working group and be actively participating in REFORMING housing policy in New York State in order to ensure that there will be sufficient affordable, accessible, integrated housing in New York State.

Lorrie Pizzola's explanation of DHCR's interpretation of Section 504 is of particular interest to advocates. This concept that 5% of units must be built adaptable, but modified upon request of the tenant, at the landlord's expense had never been discussed with advocates in the past. This new interpretation was mentioned several times by Ms. Pizzola during the MISCC meeting.

DHCR's interpretation is wrong, and it appears that they know it and are scrambling to find a middle ground that will appease our community. It is important that we all continue to push DHCR to enforce Section 504 as 5% of all federally funded units being fully wheelchair accessible and 2% being accessible for people with sensory disabilities.


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