Advocare

Fall 2007

A Publication of the West Virginia Advocates, Inc.

Increased Provider Training, Oversige and Enforcement Needed to Prevent Abuse and Neglect

West Virginia was among the nation's leaders in the closure of state MR/DD institutions. Closing these congregate facilities provided what many thought was a positive opportunity for people with disabilities to exercise their right to live in the community. The shift from institution to community created many new opportunities for individuals with disabilities. It also created profitable new opportunities for service providers in the development of community based services. With these opportunities came a significant responsibility for WVDHHR, service providers, advocates, consumers, families and concerned citizens in the community. That responsibility was to assure appropriate services and protective oversight so that individual needs of these citizens were met and to protect them from abuse, neglect and exploitation. Tragically, the evidence is growing that this responsibility is not being met in West Virginia.

In February a person with a developmental disability and a history of swallowing problems choked to death on a hot dog while eating lunch in a day program. Prior to this death, West Virginia Advocates already had growing concerns about the increase in allegations of serious cases of abuse and neglect by individuals receiving services in the community. These reported allegations were investigated and substantiated state-wide, not only by West Virginia Advocates, but with other advocacy agencies and OHFLAC as well.

WVA joined with EMS/TSN and Legal Aid of WV to express these concerns to the Behavioral Health Ombudsman and Commissioner John Bianconi. The group had hoped that our efforts would result in pro-active action by WVDHHR, including the MR/DD Title 19 Waiver office, to increase their oversight and monitoring activities and assure appropriate services and safety for individuals receiving services in the programs for which they are responsible.

To date, we have not seen any operational changes at WVDHHR to indicate any positive outcomes from these efforts to bring the issues to their attention. Much of the substantiated neglect and abuse we have investigated has occurred in settings in which providers are receiving Medicaid reimbursement for services. Some of the situations are very egregious. Vulnerable individuals remain at significant risk in situations where the potential for injury or other harm might be prevented if proper oversight, appropriate training and supervision were provided.

We believe that there are three primary factors contributing to these situations; lack of properly trained work force, lack of appropriate oversight and enforcement of rules by DHHR and some providers, and the unwillingness by some providers billing Medicaid to terminate employees where it has been substantiated that they have abused, neglected or put individuals with disabilities at risk.

WVDHHR appears to be reluctant to enforce accountability on providers for the behavior of their employees in any meaningful way. The question must be raised that if an employee fails to do their job and that job is a Medicaid service could this be considered Medicaid fraud? We believe it is.

West Virginia Advocates believe the abuse and neglect situation in West Virginia is serious and requires immediate attention and intervention. These issues cannot be solved easily or by any one group. Because of the nature of the system in place, it will require effort, commitment and collaboration by many different entities to solve these problems. The issues are critical if people with disabilities are going to live their lives in a safe environment. The real key is a change in attitude, one which places the person with a disability's safety through appropriate service delivery first rather than last. The person receiving the services has to be the focus, not the provider of the service. Neglect and abuse will continue to be a problem as long as the consumer is seen as an object to be manipulated for purposes of billing Medicaid.

The lack of a trained work force and lack of adequate pay and benefits for these crucial services has reached crisis proportions and must be resolved. While there is no magic wand, there are possible solutions. Change will occur when all of the players commit to collaborate to create that change. Unfortunately, the status quo will result in continued neglect, abuse, injury and possibly additional death for individuals with disabilities.

Service providers and WVDHHR must be accountable to their responsibilities for oversight of services, the work force providing those services, and the protection of the individuals receiving those services. Until these basic responsibilities are met, there is no assurance of safety for any of the people using these community based services.

The purpose of closing institutions in West Virginia was to improve the quality of the lives of individuals with disabilities and remove them from a living environment where neglect and abuse all too frequently occurred. We must be vigilant that we do not allow the same conditions to continue in the community.

Clarice Hausch, Executive Director