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Monthly Archives: November 2012

The Department of Aging and Disability Services issued its report on the state supported living centers (SSLCs) for the fiscal years 2010-2012.  This is timely given the budget discussions that are currently ongoing.  The report can be accessed here:

http://www.dads.state.tx.us/news_info/publications/legislative/sslclongrangeplan2010-2012.pdf

First I’ll present some of the more interesting (to me) information in the report.  Second I’ll discuss some of the challenges that DADS foresees.  Finally, I’ll discuss some of the implications and ramifications.

Information:

The first point to make about the SSLCs is that their enrollment has been decreasing over time.  Enrollment has declined by 18% since 2004.  DADS projects that from 2005 to 2015 enrollment will decrease by almost 43%.  To reinforce this point, in 2004 there were 89 more admissions to the SSLCs than separations.  In 2011 there were 124 more separations than admissions to the SSLCs.

The second point to make about the SSLCs is that types of admissions to the SSLCs have changed over the years.  The table below summarizes by comparing the percentage of admissions by admissions category for FY2004 and FY2011, there are noticeable differences.  For reference, this is an explanation of the admission categories:

  • Emergency Voluntary: Less than 12-months, urgent need of services.
  • Regular Voluntary: Placement for someone that requires treatment, services, and/or care.
  • Family Code: Minor admitted for less than 90 days, evaluation.  Admit or return to court.
  • Code of Criminal Procedure Evaluation: Adult for less than 120 days, evaluation.  Admit or return to court.
  • Code of Criminal Procedure: Adult is incompetent to stand trial.
  • Regular Admissions: civil commitment
  2004 2011
  Emergency Voluntary 0.059091 0.015267
  Regular Voluntary 0 0
  Admit Family Code 0.195455 0.267176
  Return 2 Court Family Code 0 0.175573
  Court Crim Eval Admit 0.031818 0.091603
  Court Crim Eval R2Court 0 0.022901
  Court Crim Proc 0.095455 0.053435
  Regular Adult 0.618182 0.366412
  Regular Child 0 0.206107

Some significant changes, comparing 2004 to 2011:

  • 0 children were admitted via regular admissions in 2004, in 2011 this population represented 20% of the admissions.
  • 62% of the admissions were regular adult admissions, that was 37% in 2011.
  • Almost 6% of admissions in 2004 were emergency voluntary, this was almost 2% in 2011.
  • There are more admissions being associated with the family code and the code of criminal procedures in 2011 than in 2004.

Additionally, in 2004 the percentage of residents with behavioral health challenge was 50%.  This number was 63% in Fy12.

Finally, it needs to be noted that the SSLCs are still having a staffing problem.  Looking at all facilities, only 94% of positions are filled.  Only one facility, Corpus Christi, is at 100% strength.  This may not sound like much, but it’s actually worse than the percentages make it sound.  For example, the San Antonio center is 94.35% staffed, but they have 822.35 positions and have filled only 775.85 of them – which is a large amount of coverage that is being missed.

Challenges:

DADS identifies several challenges, these include:

  • The admissions trend is to admit individuals with complex behavioral health challenges.  This requires intense and complex services/supports as well as specially trained staff.
  • The life expectancy for the residents is increasing as health care improves.  This means more complicated and expensive services and supports for residents for a longer period of time.
  • The SSLCs require a lot of maintenance, some of these are in facilities that are 100 years old.  DADS projects needing to spend almost $577 million over the next seven years to properly keep up the facilities.  Maintenance doesn’t sound exciting, but this is referring to replacing roofs, heating/air conditioning, plumbing, electrical systems, renovation of bedrooms and living areas, etc.

Implications:

As I read this report, I pick up on several concerns:

  • The population, due to health care advances, has the potential be reside in the facilities longer and cost more due to advanced age and more complicated health care needs.
  • The changes in admissions (adding behavioral health matters) has the potential to both make services/supports more expensive, but also requires different kinds of staffing (also more expensive) which may be difficult to make happen.
  • The facilities are only getting older, which makes them more expensive to maintain.

Combine the above with the fact that the population of the SSLCs is declining steadily.  The 2011 the Legislative Budget Board reviewed many of the above information and came to the following conclusions:

  • SSLCs represent 35% of the cost of caring the intellectually and developmentally disabled while serving 15% of the clients.
  • While the census of the centers has been in sharp decline over the last 30 years, the SSLCs are not being downsized.
  • Despite significant investment in the SSLCs, DADS has not been able to address the deficiencies noted by the Department of Justice.
  • There just isn’t enough money to maintain this system anymore.

As a result, the LBB recommended to the Legislature that DADS be given the authority to close one or more SSLC and to develop a closure process.  There was a lot more to those recommendations, but for this posting those are the highlights.

The timing of this report is interesting with the budget discussions currently going on and the impending Legislative session.

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Today I attended the Children’s Policy Council meeting in Austin. During the last part of that meeting, we had a briefing on how to approach the Texas Legislature from the standpoint of influencing legislation and funding. What follows are several principles for working with the Legislature.

I should point out ahead of time that this advice largely deals with advocacy groups and lobbyists. At the end of this blog I’ll have some thoughts on doing this as an individual.

The principles are:
• Some of the messages have been out there for awhile. This is important because it means that you don’t have to reinvent the wheel. If someone else has attempted to advance legislation of funding similar to what you are trying to get done in previous sessions, then that legislator can be approached. Just because it didn’t pass in the past doesn’t mean that it might not pass now.
• Other people may be working on this same issue. This includes other organizations, state agencies, and even other legislators. If that’s the case this becomes easier because you are not having to start from scratch and it’s more likely to get done with many parties interested in it.
• What are the greatest priorities? Two thoughts with this. First, it’s important sometimes to take baby steps as these are more likely to get done than the massive, sweeping reform that everyone wants. While this falls short of the ultimate mark, it allows everyone to be successful and gradually gets us where we want to go. Second, sometimes it’s okay to shoot for the moon and suffer a noble failure. The attempt gets attention and might result in good looking at the long term.
• Legislation gives things a priority and helps nudge it into happening. Not everything requires legislation, but sometimes it helps to make things important to state agencies and increases the likelihood that it will happen.
• Companion bills are essential. Legislation is more likely to be successful if a similar bill is filed in both the House and the Senate.
• You need champions. This means you need someone, or several someones, to support and move the intended legislation. Some thoughts to keep in mind with this:
o Who has expressed an interest in your agenda? These are your friends and are more likely to help advance your interests.
o Relationships with members and staff matter. Which staff members do you have good relationships with? Even if they can’t get the legislation advanced by their legislator, at least they can give you honest feedback.
o Have members had legislation on this topic in the past? If so, use them.
o Look at committee chairs and committee membership, also who has historical experience with committees. These individuals are more likely to be able to get things done.
o Get both parties involved. Bi-partisan support makes it a lot more likely for things to get through the Legislature.
o Who is the opposition? Why are they opposed? Can they be worked with? Sometimes it’s a state agency… Even if there’s opposition, sometimes you still must proceed.

All of the above requires doing a great deal of homework, but that’s essential if you are seeking to effect change.

Now, the above steps apply to an organization – like a not-for-profit. This becomes a lot more difficult for an individual, but I think sometimes the individual is more important. You can see not-for-profits and advocacy groups being tuned out by staffers and legislators, whereas the individual constituent might be able to make an impact. If an individual wants to do this, here are some suggestions:
• Legislators and their staffers know who their constituents are. If you are not one of them, you will not influence them. If you are one, meet with them and/or their staff in person, especially when they are in their home office and be professional.
• Your legislator may not have your issue as one of his/her “pet” issues. If you are interested in medical services for disabled children, but your legislator’s issue is highway construction, then he/she may not be able to effectively advance your interests. But your legislator knows other legislators…
• You still have to prioritize. Failing to do this results in you asking for things that are not possible, which tends to get you ignored.
• Don’t assume knowledge on the part of your legislator, you may need to educate. There’s a way to do this and there’s a way to appear arrogant. This goes back to being professional.
• Policy makers love numbers. Do your homework. You provide a face to the issue and provide a real, emotional, human story. But ultimately numbers sell the issue and you need to have everything.
• Don’t be afraid to testify. Testify in writing if you cannot make it to the hearing. Go to the hearing if you can, testimony from parents is powerful and a lot more likely to influence things – especially if you know your topic, speak clearly, and keep it professional.

Election day is coming up next week (November 6, 2012). After that, the members of the Texas Legislature will begin pre-filing bills. By January there will be hundreds of bills, so it’s more likely that bills will get lost in the traffic. By March there will be thousands of bills. So it’s important to get on top of this early.