Kentucky Protection & Advocacy

2. Kentucky Protection & Advocacy

3. Our Mission To protect and promote the rights of Kentuckians with disabilities through legally based individual and systemic advocacy and education. Who we are and what we do Protection and Advocacy (P&A) is an independent state agency that was designated by the Governor as the protection and advocacy agency for Kentucky. P&A's staff includes professional advocates and attorneys.

4. HISTORY OF THE INSTITUTIONALIZATION OF INDIVIDUALS WITH MENTAL ILLNESS IN KENTUCKY Kentucky State Hospital Kentucky State Hospital Danville, Kentucky Frankfort State Hospital

5. HISTORY OF THE INSTITUTIONALIZATION OF INDIVIDUALS WITH MENTAL ILLNESS IN KENTUCKY Public Psychiatric Hospitals Eastern State Hospital – Lexington, KY Western State Hospital - Hopkinsville, KY Central State Hospital – Louisville, KY Appalachian Regional Hospital – Hazard, KY

6. The Olmstead Decision • May 1995: Suit filed in US District Court in Georgia against state officials, including Department of Human Resources head Tommy Olmstead • The plaintiffs: two women with dual diagnoses of mental illness and mental retardation, who had a history of institutionalization  • Both women were appropriate for community-based treatment, but remained hospitalized.  • Lawsuit challenged their continued confinement violated Title II of the Americans with Disabilities Act (ADA) and Section 504 of the Rehabilitation Act

7. The Olmstead Decision • June 1999: Supreme Court issued its opinion (6-3) in the case, stating that: • Continued confinement violates Title II of the ADA • States shall, when deemed appropriate, make every effort to accommodate the needs of individuals with disabilities in the community  • Based on Section 504 which states, “A public entity shall administer services, programs, and activities in the most integrated setting appropriate to the needs of the qualified individuals with disabilities.”

8. DISCHARGE OF INDIVIDUALS WITH MENTAL ILLNESS FROM PUBLIC PSYCHIATRIC HOSPITALS IN KENTUCKY • Protection & Advocacy Efforts • Representation of Individuals • Participation in Transition and Discharge Planning • Filing of OCR Complaints • Voluntary Compliance Agreement Between DMH/MR and the Office For Civil Rights • Under Section 504 and Title II of the ADA, DMH/MR is required to administer services, programs, and activities in the most integrated setting appropriate to the needs of individuals with mental illness. • Unnecessary institutionalization of individuals with mental illness constitutes discrimination under the ADA • Other: • Concerns about adequacy of the assessment process • Absence of formalized transition plans • Inadequacy of community resources/providers to meet the needs of persons with mental illness

9. Personal Care Homes (PCHs) In Kentucky • Long Term Care Facilities • Defined in Kentucky Revised Statutes KRS 216B.510 • Regulated under Kentucky Administrative Regulation 902 KAR 20:036 • Licensed and Regulated by the Office of the Inspector General per KRS 216 et seq.

10. PCHs In Kentucky • There are 6,490 Personal Care Home Beds statewide • 4,479 are free-standing beds and not part of a nursing facility • Average overall occupancy is 79.88% • Location • Physical Appearance • Size

11. PCHs In Kentucky • Some of the services to be provided: • Room accommodations • Housekeeping and laundry • Maintenance services • Three meals per day and snacks • Soap, clean towels, wash cloths, and linens • Planned individual and group activities • Recreational room or space • Reading materials, radios, games and television sets

12. PCHs In Kentucky • Rights of individuals in PCH’s include, but are not limited to: • Right to be safe • Right to be treated with respect and dignity • Right to privacy • Right to receive and send unopened mail • Right to access telephone for making/receiving calls • Right to participate in social, religious, and community groups of choice • Right to keep and wear own clothing

13. PCH – Golden Years in Jenkins, Kentucky

14. PCH – Breckinridge Manor in Cloverport, Kentucky

15. PCH – Breckinridge Manor in Cloverport, Kentucky

16. PCH – Breckinridge Manor in Cloverport, Kentucky

17. PCH – Sunny Acres in Calhoun, Kentucky

18. PCH – Sunny Acres in Calhoun, Kentucky

19. PCHs In Kentucky • Population served: • Predominantly individuals with mental illness • Individuals with intellectual and developmental disabilities • Individuals with brain injuries • Individuals released from jail or prison • Age range from 18 and above (though 16 is lower age limit)

20. Payor Source For PCHs • The majority of persons living in PCHs receive SSI which is currently $674 per month. • The state supplementation program (as required by federal law) pays an amount from state general funds to supplement the SSI payment for persons living in personal care homes. • Currently, PCHs costs $1,194 with $520 paid in state funds and $674 in SSI monies. • The PCH must allow the person to retain $60 per month as a personal needs allowance.

21. 2009 Information Reported for PCHs • 3,073 individuals received the state supplement and lived at PCHs • Total expenditures reported $18,650,690 (state general funds)

22. Additional Supplement To PCH’s • PCHs with populations of persons with MI or ID/DD that exceed 35% receive an additional amount (50 cents per day). • Must be certified by OIG as having that percentage of population and following the other requirements of the regulation: • staff training • specialized group activities • specified medication administrator • licensed nurse/CMT for 1st and 2nd shifts • Thirty-three of the 83 free-standing PCHs are certified to receive this additional amount.

23. P&A Efforts at PCH’s • 2009—P & A provided training on Long Term Care Rights, information about guardianship and employment to individuals living at 20 PCHs. • 2010—P & A staff and members of our PAIMI Advisory Council (PAC) conducted rights trainings at 24 PCHs. • A total of 540 individuals attending the trainings.  • Information about employment, voting, guardianship, including restoration of rights, was provided.

24. P&A Efforts at PCH’s • 2011—P & A staff and PAC members are visiting 20 PCHs across the state. • Staff will complete a questionnaire for 20% of the population and a one page monitoring form about the facility. • These data will then be entered into a Statistical Package for Social Sciences. • Also during 2011 P & A staff conducted investigations at: • Golden Years in Jenkins • Gainesville Manor in Hopkinsville • Hilltop in Science Hill • Frasures’ in Ashland • Breckinridge Manor in Cloverport

25. P&A’s Preliminary Findings at PCHs As a result of site visits and personal interviews conducted, the following was found: • Abuse/neglect/exploitation • Not home-like • Institution-like • Desire for a different living arrangement • Limited activities • Limited access to community

26. Personal Accounts From Interviews • “I feel lonely and abandoned.” • “I would like to go to the Dollar Store.” • “I do not receive my personal mail.” • “I do not get enough food to eat.” • “We are not allowed to leave the facility after 3:00pm.” • “This is not a home.” • “If you refuse your medication, you are threatened with hospitalization or privileges are withheld.” • “I cannot call my friends or family.” • “I do not get to purchase my clothes.” • “People here eat in shifts.” • “This is better than the streets.”

27. DISABILITY ADVOCATES, INC. V. PATERSONIndicia of Institutionalization Daily Life • Medication administration • Meals • Receipt of personal needs allowances • Visitors • Daily activities at the PCH • Leaving the PCH • For doctors/mental health providers • For jobs • For fun, entertainment, visits, dining out • Organized trips by the PCH • Medical treatment in the PCH • Curfews or locked doors

28. DISABILITY ADVOCATES, INC. V. PATERSONIndicia of Institutionalization Physical Plant • Common areas • Sleeping areas • Decorating • Choosing roommates • Posted menus

29. Final Thoughts • Progress to date • Musts for the future: • Ensure integrated housing for persons with mental illness • Ensure access to other needed services and supports for persons with mental illness • Re-think utilization of current resources • Recovery means living like people without a mental illness live; such as, having your own place to live, a job, access to health services, and transportation.

30. Contact Information: • Marsha Hockensmith, Director • Kentucky Protection and Advocacy • 100 Fair Oaks Lane, Third Floor • Frankfort, KY 40601 • (502)564-2967 or 1-800-372-2988 • http://www.kypa.net

31. Welcome ~ Sheina Murphy • Sheina Murphy is from Paducah, Kentucky. • She is a Peer Specialist and provides training to law enforcement officers using the Crisis Intervention Training (CIT) model. • She is also member of numerous councils and boards including: • The Department for Medicaid Services Advisory Council for Medical Assistance • The Protection and Advisory for Individuals with Mental Illness Advisory Council • The Kentucky Mental Health Coalition