Get Involved
Many thanks to the hundreds of Iowans who provided comments and suggestions during the development of the DHS Olmstead Plan for Mental Health and Disability Services.
DHS extends a special thanks to the Olmstead Consumer Task Force, the Mental Health and Disability Services Commission and the Mental Health Planning Council for their careful review of the Plan, and their comments and recommendations.
For a record of stakeholder input sessions since 2009, please read Stakeholder Participation Opportunities.
Before the State Plan Framework was finalized, four public forums were held across the State in the fall of 2010. To review the record of the forums and the response by MHDS to the stakeholders input provided, click on the links below.
- Mt Pleasant Olmstead Forum Summary_(10-14-10)
- Clear Lake Olmstead Forum Summary_(10-28-10)
- Ames Olmstead Forum Summary_(11-4-10)
- Iowa City Olmstead Forum Summary_(11-23-10)
As an individual who is disabled due to emotional/mental conditions, I find that much of what is outlined here doesn’t apply or is not helpful to me. I am capable much of the time and as such resources are deemed to be better allocated to those who benefit from a more intensive and regular intervention. Until I don’t function, and it’s back to the bottom of the waiting lists again. I’m not sure if the failure is necessarily in the system as such, or in accessibility during times of crisis in those who suffer from conditions such as anxiety disorders, bipolar disorder, or any host of personality disorders. These can be totally debilitating at times, while at others providing only minimal functional impact insofar as necessitating the use of outside resources.
While this is only one small subset of the scope of the directive, it it is a unique and challenging subset whose needs could be better met by the availability of a multipurpose short term “adviser” for lack of better term. For those who do not need vocational rehab, or a full time case manager, but come up with a challenge like re certification for a program involving a lot of paperwork, or an unexpected need to find a place to live, someone offering short term support could very well stave off a much larger and costly crisis.
Thank you for your comments.
I’ve been trying to keep up with the changes in the redesign in hopes of understanding what i can do as an individual with disability and aging with this disability. Nothing has improved for me in many ways. As of yesterday (12-27-2011) the transportation service i use for grocery shopping (10 years) has blocked my telephone number. I’m thinking this must be their way of telling me that i no longer qualify for their services:/. Hello, isn’t eating part of the plan. And who do i contact at such short notice of this determination.
Not real impressed with the MHDD office thus far. My mother has called at least 4 times over the last 3-4 weeks and I have stopped by once. She is looking for assistance in completing an application for my 17yo disabled sister. She has been told that the office is moving, that they are busy, that so-and-so is out. She inquired about scheduling an appointment, but was not able to do this. When is someone going to get back to her? Who is she supposed to contact or meet with to get her questions answered?
I agree that the state needs to stop trying to “warehouse” our kids in institutions. My daughter who has an IQ of 49 with seisures and mental health issues was asked to get put on a waiting list as early as her first year in Jr. High school. The trend until then had been to place the child as early as graduation day.
It became rapidly apparent to her dad and I after visiting one of these places in which his brother and sister were already placed that this was not the place for our daughter.
I am 53 years old and I am infuriated that more support systems are not put in place to keep these kids out of such places.
Through the consumer choise program a stranger or someone I know can take care of our 19 year old daughter for $15.00 an hour.
She is on dissability and we drive ourselves crazy trying to remember to save receipts, because as her payee we could be imprisoned if every penny is not accounted for.
We love our daughter dearly and are told that if she is ever able to live independently that we could actually be paid for helping her with living skills but as long as she remains in our home, where we care for her 24-7 except date night,we are out of luck.
What options are there for parents such as us? If our child was physically dissabled we would qualify for caring for her. What kind of job can I get when it must revolve around her counselling sessions, trips to the neurologist, dermatoligist, vocational rehabilitation counselling sessions,seisures etc?
Our alternative is to continue to struggle to give her not just a home, but OUR HOME, to live in while a stranger makes $15.00 an hour to give us a 7 hour break once a week.
She is 19 years old. Tell me what the incentive is for not placing her, other than the fact that we absolutely love and adore our daughter and can not stand the thought of placing her somewhere like that.
I have a friend who is in serious need of help. He is currently incarcerated but had a brain bleed on Dec.6 and was in University of Iowa hospital until Dec. 20th when he was placed back in IMCC due to not being able to secure the finacial support to be placed in an intense rehab program such as Younker’s Rehab or a skilled nursing facility. He was in the Fort Des Moines work Release program and was about to graduate from there when this happened. His counselor from the fort recommended we get him into a skilled nursing facility ASAP. The DOC will not pay for one but would give him a medial discharge if it was finacially taken care off. Meantime he is not getting the physical therapy regimen he needs and may not be able to walk if help isn’t found. He has little movement on his left side of his leg and arm. We haven’t been able to get medical info on him since Dec. 20 but at that time, he had a feeding tube due to not being able to swallow adequately yet, on oxygen, paralyzed on the left side, not able to turn self over in bed, no brain flap (skull) on the right side, and was receiving insulin shots. University of Iowa is suppose to be doing the Therapy for IMCC but the social worker at U I hospital had recommended finding him a rehab program before he was sent back to IMCC because they didn’t have an intense enough program for his needs. If you have any assistance you can refer me to please let me know as I am terribly worried for him and can’t even check up on him. We even have to redo our visitation form and be reapproved before we can visit him.
Thank you for any assistance.
Debra Saville
The Consumer Choices Option needs to be substantially modified. Namely, the Independent Support Broker should be eliminated or made optional. As a grown man who has been on his own for many years, I find it downright insulting, and burdensome, that I am required to have an outsider ‘help’ me manage the CCO money. That is paternalism at its worst! Maybe there are those who need an ISB due to cognitive or emotional problems, or lack of skills. I completely understand that. But, folks like me who are independent and educated (I am a newly minted Ph.D.) do just fine by ourselves with money management. The ISB issue has me so upset that I almost regret getting my Medicaid Waiver in the first place. Things need to change quickly.
As an Iowa licensed psychologist, I found your goals without any problem. However, there is a total lack of consideration of the lack of clinical services. In particular, “Iowa Care”
patients have a gross shortage of services, most importantly when it comes to psychotherapy and family therapy. The “Iowa Care” population is one of the most needy, yet they get the longest wait and the least amount of “counseling or psychotherapeutic services. U of Iowa psychiatric service cannot meet the needs of this more desperate part of our population. Mental Health plans must include a delivery of services. The issue of cost is always a concern, but in general that part of the population with the least services becomes a consumer of legal, corrections and family crises, costing other services that are not able to meet the source of the problem.
I have had Spina Bifida for 45 years. JUST 6 MONTHS AGO I found out about the MEPD Program… I was carrying my own insurance for 40 years at nearly $700 a month!! With MEPD I pay $70… I could have saved a ton of money if I ONLY KNEW ABOUT THE PROGRAM!!! I have No savings…… ( and do NOT have another 40 years to build it) I need Home Modifications . Look at the individuals needs.. I am employed and doing well now, but what about 2 months from now?? Just because I can bathe myself, does not always mean I am able to do laundry/ cook/clean I may need in home help with some things and not others.. maybe there could be a “sliding” fee for this assistance. I WANT to remain INDEPENDENT,stay in my house and be a productive citizen. Everyones Needs are DIFFERENT… I want to be treated as an INDIVIDUAL..Not a case number that is floating around in Cyber Space!!
It would be essential that any vision for improvement in services for an array of client groups – MH, SA, Education, Courts/correction, etc – recognize and address the proper treatment for what is the most common etiological denominator for problems, i.e. the development of the human emotional system in the context of family dysfuction, or what is commonly termed complex trauma. The ACE study has been widely discussed, it and other studies highlight the need for all human helpers to recognize that the emotional system is the core of our psychological and physical (sympathetic and parasympathetic nervous systems) being and disruptions in its development reverberate across the lifespan in the form of psychological and physical dysregulation unless properly addressed and resolved. We need to get away from the conventional terms of Mental Health and Behavioral Health and call it what it is – Emotional Health – and appreciate that emotional trauma is the experience of being emotionally helpless – the younger one is the more vulnerable to emotional trauma and the harder it is to be fixed (a variety of developmentally primitive dissociative defenses need to be identified and treated.) Addressing emotional trauma at any age is the key to resolving all manner of health and behavioral issues. Time does not exist for the emotional mind – once incurred, emotional wounds are implicit, predominant, and unvarying within and between human beings.
Having recently moved to Iowa City, IA from AL I find there are several areas that are lacking for those with disabilities to better be served. First Housing, there are not enought accessiable housing units to serve those that are in wheelchairs. Secondly, transportation hours are cut short here in Iowa City on Sundays. Thirdly, job services, the lack of funding for vocational rehabilitation counseling doesn’t meet the need and demand of those that may want to work, but need assistance in getting and maintaining a job.
When will this service be offered in Des Moines County. I’ve been severaly disabled for over 22 years and this county has done absolutlely nothing for me. If this program exists they need to use it.
The plan is well organized and well written. Input from community providers is evident in this plan as we are invited to assist in the process. DHS and legislatures focus resources on research, brainstorming and writing the perfect plan to meet the requirements of the law, what is fallen short on typically is follow through. What are the next steps for implementation and funding?
1. The State needs to support the community providers in order to make the plan come to fruition. Training will need to be considered as a direct cost of providing services. Changes will need to be made in the current cost reporting system for HCBS.
2. Reimbursement for providers must be increased to recruit qualified staff and be able to compensate for their experience to match what is offered at the state institutions.
3. Equal accountability for both DHS and community providers is paramount to plan implementation. Quality reviews must be broadened to include more that just crossing t’s and dotting i’s.
First of all, the Olmstead Plan seems to include many facets. It is evident that thought and effort has been put into the plan. This being said, I have input for the Olmstead Plan for Mental Health and Disability Services dated 10/07/10:
1. There are good goals to increase access to services. However, there are true barriers that the plan should better address. Iowa lacks child psychiatrists. While this could be considered as “build capacity,” it would be good to see this specifically said.
2. More could and should be done in Iowa to increase children’s mental health screenings and services right there in the schools they attend. Barriers and solutions could be identified. Positive reasons for increasing this are many.
3. In Obj. 2.2(c) says, “Collaborate with the Iowa Department of Public Health and other state agencies to address methods to reduce suicide risks among teens and young adults.” This step would be enhanced by also specifically naming the Department of Education as a partner.
4. Objective 2.4(c) says “Establish vehicles for communication among law enforcement, the judicial branch and MHDS about options available for diversion, and alternatives to arrest, detention, incarceration and commitment.” While education about options is good, this step could go farther by saying jail diversion programs will be established.
5. Please be careful on how objective 2.8 is implemented. Functional assessments are OK and can be good indicators of services needed. However, functional assessment processes can keep people from getting services they need, when they need them. For example, in Iowa individuals are not getting Targeted Case Management services when they can most benefit, right away, because of the assessment process. Can it be possible for a person to be approved for Targeted Case Management services right away, and then have an assessment completed two to three months later to determine if the service should continue? For example, private insurance often approve a limited number of physical therapy sessions, then require assessment and documentation to continue treatment. Please apply this principle to Targeted Case Management and other services as well.
6. In Objective 2.10(e), it says “Explore strategies to enhance access to services in underserved areas, including rural communities, through tele-health and other technologies.” This is fine and should be done, but only puts a bandaid on the real problem, a shortage of mental health practitioners. There are not enough psychiatrists in Iowa.
7. Objective 3.3(d) says “Build community provider capacity for Supported Employment Services.” To build capacity, please address a key problem with competitive employment….funding. There are places in Iowa where Supported Employment is unavailable, because providers can’t afford to offer it. They lose too much money. The rate is capped too low, especially for all the oversight, documentation, requirements, and what is considered billable activity.
8. Objective 3.5 says “Build the capacity at all levels of service to serve individuals with intensive needs.” The action steps do not address a true problem, funding. More providers would offer more services if they could afford to do it. Forty-three Residential Care Facilities closed in four years in Iowa, with a key problem being funding. Iowa increased funding to state resource centers 43% in the past four years (which does not include state employee overtime!) and gave community-based providers 1.4% in the same time period (which does include employee overtime). I would suggest looking at controlling costs in state resource centers and shifting saved dollars to better fund community-based providers.
9. Objective 4.3 says “Develop a statewide retention and recruitment plan for the direct care workforce in all settings and programs.” There is currently a movement in Iowa to offer credentialing of direct care workers. This is fine, and a good idea. However, community-based providers who get an increase of 1.4% in four years struggle to pay direct care workers appropriate wages. An earlier commenter noted the entry wage for State Operated MR/DD Institutions is listed as $13.82; the entry wage for Private providers is listed as $9.36. A suggestion I have would be to decrease expenditures in the State Resource Centers (perhaps even eliminate one), increase rate caps for community-based providers, and allow said providers to pay staff higher wages.
10. Objective 4.6 addresses neglect, abuse, discrimination and exploitation. Financial exploitation happens all-too-frequently. I would like to see the State offer training to banking professionals on identifying and reporting financial exploitation. I spoke with a local banker, who said there was not systemic training specifically on this topic to his knowledge.
11. Objective 5.2 states “Expand outcomes measurement and reporting systems, with standardized processes to monitor consumer outcomes.” Action steps that follow put a great deal on the “to do” list. I would encourage the State to consider duplication and inefficiencies in the accountability area. Within 45 days, there were two auditors who came on site to review LifeWorks Community Services’ SCL Hourly program. If resources were combined, it would have saved everyone money and time.
12. Thank you for Objective 5.4(a). Points I made earlier about Supported Employment funding could be achieved with this step. Please do not limit this to Supported Employment. Too many providers are losing too much money providing hourly Supported Community Living, the “gold ring” to attain in residential services.
13. Objective 5.5 is a good and bold objective. However, it needs action steps.
14. There are a significant number of Iowans getting services outside of Iowa. “Building capacity” is in various places in the plan and can solve this problem. However, I don’t recall seeing that Iowans would be encouraged to return home to Iowa. I think the plan would be enhanced by identifying this issue.
Having read many of the comments already made, I would agree with many. Money seems to be the topic of interest. I don’t know how someone would argue against moving people into the community if the individual can be kept safe, the staff working with the person can be kept safe, and the community can be kept safe. Unfortunately, the answer to all three of these caveats may be “No, we cannot”. There needs to be a strong support system in place in the community before people are moved. Too many projects in deinstitutionalization going back to the 1970′s were answered by closing buildings but not creating a support system for those living in those buildings. Money is an easy remedy. If there is enough money, a system is developed, staff members are properly and highly trained (which also means properly salaried and benefits), and the community is prepared. If Iowa is truely interested in moving people into the community, the money must go first to prepare the path. Then the money must be there to continue to support the system. My true negative and disillusioned bias is that we have not done this in the past as we continue to spend millions on institutional care rather than community-based. We continue to spend funds on buildings for work centers and cut funds for employment services in the community. A change is needed to shift our focus. The plan must create this. Unfortunately, money may be the answer and our citizens with disabilities have never been a priority in this state.
I am impressed with the work put into the document and the efforts of those involved. I hope their efforts are not wasted.
My first Comments were evidently not deemed appropriate so I will try again. Our system for serving persons with intellectual disabiities in the community is broken. It is broken as the State still maintains a quiet bias towards institutional care. Non-profits and for-profit Community providers need some incentives to be of value in providing individuals with integrated lives. You cannot increase State run facilities 43% and do anything of value to keep community programs alive and well. This is truth. I hear Georgia has a new five year plan to actually adress the institutional system there. Perhaps Iowa should do the same.Good plans are great. Iowa has just never implemented any of them I have read in 30 years.
As parents of a Consumer Choice young adult I just want to add that this program does an excellent job of letting the disabled live at home. Please protect this option as you look to improve all programs.
Thanks
I agree 100%.
Consumer Choices Option has resulted in tremendous improvements in our son’s life (and ours
!
The problems that need to be resolved are:
No training or manuals for consumers, staff & Personal Reps, IBC’s.
No Parent/Personal Rep Group.
It would be nice to be able to recommend staff to each other
I believe New Hope of Carroll, IA has demonstrated evidence of embracing the goal of assisting individuals in moving to settings that offer optimal community integration:
1992: Assisted 33% of RCF.MR service recipients into residential service settings that offer optimal community integration
1994: Assisted 25% of ICF.MR service recipients into residential service settings that offer optimal community integration
2003: Assisted additional 50% of remaining RCF.MR service recipients into residential service settings that offer optimal community integration
As one of the first Iowa providers of disability services in a community setting, we now serve the majority of clients receiving residential services in integrated settings.
Through our experience, we have identified barriers that continue to plague our further service enhancements. Those being:
1. Workforce challenges. As reported from the Iowa Fact Sheet, regarding Work Force Issues, on the ANCOR website: http://www.ancor.org/sites/default/files/Iowa%2009.pdf. As of 7.09, the entry wage for State Operated MR/DD Institutions is listed as $13.82; the entry wage for Private providers is listed as $9.36.
2. Affordable, accessible housing. Significant upfront and out-of-pocket investment dollars are needed.
3. Lack of accessible evening and week-end transportation forcing the provider to provide the transportation. This results in inadequate reimbursement for the cost of purchase and maintenance of vehicles. In addition, validating records of drivers is categorized as an indirect expense.
4. Speech Therapy, Physical Therapy, & Occupational Therapy services cease being funded when the Medicaid recipient is no longer making progress. Inadequate funding for services available for maintenance of the skill level attained in these areas of need. Lack of community speech therapy providers able to devote the time needed for obtaining, programming, and maintaining augmentative communication aids.
Sorry to be a buzz kill to some writers above…But I would say the state should put its money where it says its philosophy is.If the State truly wants community based services for persons with Intellectual disabilities, they should know that Actions speak louder than words. Until Officials admit that Iowa still has an institutional bias (state willing to pay triple for State Owned Facilities over Private Community-based)…Nothing will ever change to move individuals to full inclusion. Words and wonderful plans are great,I have seen many.. but they mean nothing to a 30 year veteran of providing community services like myself, because they never have come to pass. I need actions by the state that actually make me believe they really want full integration; Actions to give me some indication they even want community providers to stay in business. The State Government and the real world of free market have never met. In order to sell a service or a product in our Great Country,everyone, including us poor non-profits, need motivation to do so. There is no Carrot on a stick..there is only a stick. I am sorry for my bitterness, but I have met the stick personally. My Good heart and proven integrity means nothing when I can’t pay my staff what they deserve for believing in community services.
As a 10-year veteran of community based services, I agree. The amount of time that is wasted on plans that never go anywhere is frustrating. There is a disconnect between those in the service industry and those who pay out the money. It all sounds wonderful on paper, but when it comes to spending the money, the state often does whatever is cheapest.
I consider myself a young professional, and I am somewhat new to human services. This is a job that I have thoroughly enjoyed for the past four years (employment services—primarily ID/BI waivers and Habilitation services), and I could see myself staying where I am for many years to come. That being said, I am often frustrated by things that are out of my control. When I started my career, I was trained that everything is about consumer choices, but in reality, it is more often a matter of who will pay for which services. On my current caseload, 32% receive Pre-vocational services, 27% are happily employed in the community, 5% want a community job but are waiting a waiting list (IVRS), 23% currently or soon will only participate in full-time Dayhabilitation services, and approximately 13% fall into an “other” category. This is quite different from four years ago, when approximately 80% were authorized for Pre-vocational services and were allowed to earn money and improve their skills in a sheltered workshop setting. I truly understand the philosophy of encouraging clients to leave pursue community employment and leave the workshop, but I do not see the philosophy behind forcing clients out of workshops. The agency I work for has made great efforts to carve out jobs for individuals and find employment, with the help of visual resumes and other accommodations. We have had some success, despite the devastating economy. Integrated community employment is my first choice for anyone who is interested, able and motivated to pursue this option. However, I also have many people who are not interested in community employment and want to work at their job in the workshop. Quite honestly, many have been forced out of Pre-vocational and workshop services. Some common reasons for denying Pre-vocational services include: he/she has not made enough progress, he/she has been in the program too long, he/she is not interested in a community job, etc. After being denied Pre-vocational funding, my clients do have the choice of pursuing community employment, but even if this is a realistic choice for someone, there is a long waiting list for funding approval. The other choice is Dayhabilitation services, which offers many integrated opportunities, but lacks the fulfillment and paycheck that comes from working in the workshop. Personally, I do not understand the logic behind forcing people out of sheltered workshops, and I am not the only person who believes that we need an option for people who do not want community employment but still want to work. When Pre-vocational funding is denied, I am often the person that needs to explain this to the clients and families I work with, and it breaks my heart. I often wonder, “Where is the choice?” and “Why is it more appropriate to deny workshop services, which my client wants, and replace it with services that are more expensive to operate and my client does not want?”
Iowa has been moving to create seamless systems of care in Iowa for the 40 years that I have been a social worker here.
Money is an obstacle in implementing the Olmstead Decision.
The State of Iowa will improve its own economy & have more money for services when they decide to stop spending Iowa money in other states to provide services for people with disabilities.
Rates for out of state placements are over five times that of community providers per schandler@iowaproviders.org. Daily rates for out of state placements exceed $1000, with some exceeding $1500 a day.
PLEASE fund Iowa people in Iowa, not in other states. It will stimulate Iowa’s own economy. It will bring families back together.
It has been very challenging, to say the least, for community providers to sit back and watch State run resource centers recieve rate increases of 43% over the past 3 years provide the same service. Many consumers “want” to stay in Iowa. We have the right to decide where to live/work and so should they. Rates for out of state placement are over 5 times higher than community providers. Think of how much money could be saved. Community providers offer a “sense of family atmosphere” to our clients in turn increases their daily quality of life, which they rightly deserve. Rather, providers are being judged by paperwork.
I found the plan to be encouraging and inclusive, and I also appreciate the opportunity to provide feedback. While the plan is a solid first step, it seem that full implementation and actual outcomes for people served can come only when our behavior as a system matches what we say we’d like to achieve. We indicate value of community over institutional services, but our systematic behavior seems to value the institution over community. For example, State run resource centers have received significant rate increase over the past three years while community providers of the same service have had much smaller (1.4%)increase. In addition, existing rates for resource centers are nearly triple that of community providers.
It seems that everyone can agree on the importance and value of employment. However, funding for employment services that assist people with disabilities in obtaining and keeping community jobs does not mirror that value.
Current accountability and quality measures focus on crossing t’s and dotting i’s within substantial amounts required paperwork rather than providing high quality, innovative, community-based services with real outcomes in people’s lives.
Expansion of use of CCO for people receiving Waiver services may be better facilitated if Iowa’s rules were not more restrictive than Federal guidelines as related to independent support brokers.
As we continue to move toward full plan implementation, I hope our behavior as a system and as a state can do more to demonstrate what we say we value.
Thank you.
The ideas are great; the reality of Iowa’s system simply do not support the ideas, and many things will need to change before any of this can be implemented. The following points are illustrative:
1. State run resource centers have had rates increased 43% over past 3 years while community providers of the same service have had an increase of 1.4%. Supposedly the state resource centers are required to meet the same standards that community providers meet, yet they are not subject to the same types of usage and financial audits that providers are subject to. This is clear evidence that Iowa supports institutional settings over community ones.
2. Rates for resource centers are nearly triple that of community providers (rates do not include overtime pay to state employees). Rates for out of state placement are over five times that of community providers. Again, clear evidence that Iowa values institutions over community providers.
3. Employment in the community – this service has been decimated in the provider community over the past six years by a business decision by IVRS in the way they contract for services with community providers (referrals to our agency from IVRS dropped by more than 75%). Providers have facility based services to pay for the loss they take by providing supported employment. Our organization has lost between $30,000 and $50,000 in each of the last five years.
4. Current accountability and quality measures as written in rules and regulations essentially indicate that value is determined by crossing t’s and dotting i’s rather than providing high quality, innovative community based services. At last count, our industry was subject to various inspections, audits and accreditations by over 30 different entities. A banker on my Board of Directors commented over five years ago that the level of accountability then was far greater than accountability for the banking institutions; the level of accountability has increased significantly in that period of time.
I applaud the people who created this plan. I believe in and uphold the principals on which it is based. Community providers have tried hard to implement services that mirror those principals, with very limited resources. I doubt that the plan can be implemented because I don’t believe the legislature or DHS have the intestinal fortitude to make the changes that are necessary for implementation.
Jean M. Rommes
Non-Profit and For Profit Community Providers are struggling. We have been penalized with rate deductions while State run resource centers have had rates increased 43% over past 3 years.
If you go onto the state website, you can see how much overtime is paid out to employees at the resource centers. It would make sense to keep Iowans in Iowa at the reasonable rate community providers have versus $300 to $900 (maybe more) per day rates for resource centers and out of state placements.
Community providers can not afford to provide supported employment options for those that need this service.
Assisting our clients with their life and happiness is no longer the priority with the current accountability and quality measures as written in rules and regulations. Rather we as providers are being judged on ‘pretty’ documentation.
1. Improve the service rates for community based services and supports. Currently the state-run institutional settings have rates risen by 43% over the last three years. The rates for community based service providers have only risen 1.4% in that same time. Throw in the fact that the community based rates were far less to start with, this is a real barrier to community driven support systems.
2. Support a more holistic approach to community employment for individuals diagnosed wtih disabilities. The current system is nearly non-existent in terms of employment for this population.
3. There is no room right now in the current regulatory system for a true indication of quality care. Current regalutory practices emphasize paperwork and documentation over actual care given to the individual and family. This fact drives many resources away from provision of care and into “non-care” line items.
When it come to employment in the community, providers like Goodwill have been very successful at placing people with disabilities and providing the job supports necessary for success. This service has been dramatically decreased in the provider community over the past six years due to a business decision by IVRS in the way they contract for services with community providers. In addition, providers like Goodwill have facility based services to enable the disabled to reach their potential.
In the past three years the state run institutions have benefited from a 43% increase while those providing services to the same population in the commnity have recieved only a 1.4% increase. Our staff are equally deserving of quality wages and benefits and those they serve are equally deserving opportunities to live in the community of choice.
The idea to transform the current system is not new. It seems that as soon as any changes are made whatsoever; talk begins immediately about how it needs changed again. It seems that we’ve been working toward transformation for years. Some of these ideas are good and some are not feasible. I find it frustrating, however; that while we talk about improvement, the financial climate get’s worse in regards to funding any system changes. The State of Iowa is still operating under mandatory budget reductions and waiting lists can be found everywhere in all levels in many different areas that goes beyond mental health. If “we” can’t maintain current programs….how could we ever hope to fund programs that have yet to come and are still in the planning stages? Unfortunately, money is required to get these things off the ground and unless you plan to take from one to fund another; the end result is that someone, somewhere, will suffer.
It is wonderful to see the efforts of so many stakeholders’ meetings and collaborations over the past decade (or more) culminate in these important documents. The goals are idealistic in their scope, but, as an eternal idealist myself, I am pleased and inspired.
You’ve hit all the highpoints in the description of a transformed system–”People . . as active members of their communities,” “Timely access,” “Competetive employment” (code for “inclusive) as the goal, “Resiliency and recovery,” “Skilled (and valued, I might add) workforce,” “Personal responsibility and self-direction,” “Individual and family involvement at all levels,” “Innovation and progressive strategies,” and “Adequate funding” say it all.
My own interest is in enhancing the skill of providers and having accountable services that indeed show improved quality of life as experienced by the consumers of those services. There is much work to do around this and these documents provide the overall framework. Now we need to make it happen.
Another area of special interest is creating “seemless” systems of care (specific interest in children/families). There is much to do here as well as the present environment does not promote this.
I look forward to seeing our progress and doing the work to make these ideals realities across Iowa.
If there is to be public awareness and inclusion, empowerment and collaboration and partnership in building community capacity then the whole way the disabled and mentally ill are viewed and expectations for them must change. From preschool or the onset of a disability it must be made clear that society has expectations of us all, and though we are willing to help there are no free rides. That means parents must be convinced their child can and should aspire to more than just collecting SSI.
I am glad to be able to comment on this exciting process of developing a plan for Iowan’s with disabilities and mental illness of all ages and Iowa’s aging/elder population; while meeting Iowa’s obligations under the 1999 Supreme Court’s Olmstead Decision. Thank you for this opportunity.
The clear and over arching message in this plan must be that the Olmstead Decision states that individual with disabilities, mental illness and the aging/elderly must be provided services in the least restrictive most integrated setting possible, and that is Iowa’s commitment. Community placement first and facilities and institutions only as a last resort must be the philosophy.
Building community capacity is going to require a commitment at the state level of multiple agencies as well as counties, municipalities and the private sector for housing, employment, transportation and health care to name a few. Has consideration been given to or have these entities been reached out to for their input and support? For it will surely fail without them.
If there is to be public awareness and inclusion, empowerment and collaboration and partnership in building community capacity then the whole way the disabled and mentally ill are viewed and expectations for them must change. From preschool or the onset of a disability it must be made clear that society has expectations of us all, and though we are willing to help there are no free rides. That means parents must be convinced their child can and should aspire to more than just collecting SSI.
The school system must work with students as soon as possible on necessary life skills and occupational skills needed to live as independently as possible and not a sham curriculum of mainstream classes and pass them on which is the current dirty little secret. If no expectations or challenges are presented to or placed on individuals with disabilities or mental illness none will met or successfully accomplished. If we expect nothing we get nothing.
Thank you for your commitment to Iowans with disabilities and Iowans with mental illness. I have several comments to share. Thank you for the opportunity to provide feedback.
The Olmstead Supreme Court Decision was intended to cover ALL people who have disabilities, and/or who have mental illness, and/or who are elderly to ensure that community supports and services are available so that no one is forced to live in an institution. I would like to see this state plan include language that identifies the aging/elderly population as another group that will be served.
DHS provides significant amounts of services for older adults through Medicaid. In fact of the roughly $533 million in public funds spend in Iowa on long-term care for Iowans age 60 and over, $494.18 million comes from DHS/Medicaid – that’s more than 90%.
Building community capacity for home and community based services for people with disabilities, people with mental illness, and people who are aging will require the involvement of many other state agencies, including DHS, Department on Aging, and other agencies that oversee housing, transportation, and assistive technology, to name just a few. How can we get these other agencies involved to help us develop a strong plan that includes all areas of services needed by these populations?
In order for this plan to be a State Olmstead Plan, it has to include the aging population as well as other state agencies that provide services and/or address the needs of the disability, mental illness, and aging populations. I think DHS would welcome specific ideas for how we can develop these kinds of collaborations within this plan to make the overall plan stronger.
As a member of the Iowa Olmstead Consumer Task Force, I will continue to work with a committee from that Task Force that is working with DHS and other partners on this plan. I truly appreciate the commitment of DHS leadership and staff to the development of this comprehensive plan.
-Dawn Francis
Executive Director
Iowa Statewide Independent Living Council (SILC)
I am impressed with the quality and comprehensiveness of all the documents. I was pleased to see the inclusion of shortages of mental health workers, use of evidence-based programs, and access to care as issues to be worked upon. We serve older adults and understand the great need for mental health services especially in the most rural parts of our state.
Thank you!