Union Raises Strike Possibility At Northern RI DD Provider Over Submarket Wages; No Deadline Set

By Gina Macris

Unionized workers supporting about 250 adults with developmental disabilities have indicated they may strike at Seven Hills Rhode Island over wages that lag significantly below those in neighboring states. No deadline has been set for a walkout.

The possibility of a strike by about 180 members of the United Nurses and Allied Professionals (UNAP) was disclosed in a letter that the management of Seven Hills sent to families Jan. 15. Talks between labor and management continue, according to a source with knowledge of the negotiations.

An official of the state Department of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH) indicated that the union must give a 10-day notice of any walkout.

Kevin Savage, Associate Director for Quality Management, said Jan.18 that “BHDDH is in close contact with Seven Hills administration, who have put together a plan to ensure coverage of necessary services in the event that the union gives them a 10-day notice that a walk out will occur.”

He said BHDDH contracts with Seven Hills to support about 250 persons with developmental disabilities in a variety of residential settings, as well as supported employment services and non-work daytime activities.

The Jan. 15 letter to families, signed by Seven Hills’ vice president, Cliff R. Cabral, said that a work stoppage could force the agency to suspend or reduce “several program offerings.”

“Our day services program will be limited to 24 residential participants,” Cabral said. Seven Hills has 76 residential clients, according to the latest data compiled by the state.

Efforts to reach Cabral or a UNAP spokesperson were not immediately successful.

Average entry-level wages for direct care workers in Rhode Island are $11.36 an hour, according to the most recent figure released by the Community Provider Network of Rhode Island, a trade association representing two thirds of the private providers of developmental disability services in the state.

Governor Gina Raimondo has proposed an incremental raise – estimated by BHDDH at an average of about 44 cents an hour – effective July 1.

In Connecticut, entry-level direct care workers must be paid a minimum of $14.75 houirly. The Connecticut legislature approved the raises last May, even though it had not yet acted on the state budget, to avert a strike that had been planned at that time by the Service Employees’ International Union (SEIU). The wage hikes became effective three weeks ago, on Jan. 1.

SEIU also has negotiated a $15 hourly minimum wage with Massachusetts for direct care workers in that state that went into effect July 1, 2018.

In the letter to families, Cabral said that “Seven Hills Rhode Island stands with our employees and will continue to advocate on their behalf for the living wage they deserve.”

He said Rhode Island’s system of care for adults with developmental disabilities still has not recovered from the General Assembly’s $24 million reduction in services in 2011. (Final figures on actual spending put the total over $26 million.)

Despite repeated and concerted advocacy, “our state representatives continue to place funding for individuals with developmental disabilities low on their priority list,”he said. The General Assembly’s inaction has significantly “compromised the sustainability of the current system,” which, Cabral said, has been weakened by below-market compensation and high staff turnover.

“Organizations such as ours have taken several painful measures throughout the past decade in an effort to ensure our fiscal sustainability, including liquidating assets and significantly reducing our administrative resources,” Cabral wrote.

While it has adhered to the “highest delivery standards possible,” Seven Hills cannot sustain its efforts indefinitely, Cabral said. He called on UNAP to join with management “to more productively direct our collective efforts toward lobbying for a substantial investment in this year’s state budget in order to adequately address the needs of those with developmental disabilities while ensuring a living wage for the remarkable individuals who support them.”

Seven Hills Rhode Island offers a variety of services for children, families and adults, with offices in Cranston and Woonsocket. Services for adults with developmental disabilities are based in Woonsocket, covering northern Rhode Island.

Public Hearings Scheduled Sept. 18 On RI BHDDH Proposed Regulations

By Gina Macris

Long-awaited revisions to regulations governing Rhode Island’s services for adults with developmental disabilities, as well as other functions of the Rhode Island Department of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH), are to be discussed in public hearings Tuesday, September 18, at the Arnold Conference Center in Cranston.

In the Division of Developmental Disabilities (DDD), the changes are intended to give providers the flexibility to better tailor services around the unique needs and preferences of each individual, according to Kevin Savage, the Director of Licensing at BHDDH.

On Aug. 21, before the proposed regulations were made public, Savage agreed to describe the purpose of the changes in general terms. He said he would be was prohibited from making any remarks once the public comment period opened. That happened Sept. 6, when the proposed regulations were posted on the Secretary of State’s website. Written comments will be accepted until Oct. 6.

An index with links to the rules proposed for adoption – and those proposed for repeal - can be found here:

On Sept. 18, the hearing schedule will be:

  • 11 a.m. Developmental disability regulations

  • 1 p.m. Licensing regulations for all entities that operate under the auspices of BHDDH

  • 3 p.m. Behavioral healthcare regulations

The regulations are part of a broader context that includes standards of quality which developmental disability service organizations must meet to obtain and keep an operating license.

Until now, the standards of quality have been part of the regulations, which carry the force of law. But Savage, the BHDDH licensing director, has said that arrangement stifles the flexibility of providers to tailor services to the needs of individuals. Providers have also complained of lack of flexibility, particularly in light of demands of the 2014 consent decree which mandates integrated day services.

In the proposal, the standards of quality, or “certification standards” would no longer be part of the regulations, but instead serve as guidance about what organizations must do to become licensed or have their licenses renewed.

Here are links to the quality, or “certification” standards.

Day Services Employment Services Residential Services Shared Living Arrangements

  • Long-awaited revisions to regulations governing Rhode Island’s services for adults with developmental disabilities, as well as other functions of the Rhode Island Department of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH), are to be discussed in public hearings Tuesday, September 18, at the Arnold Conference Center in Cranston.

In the Division of Developmental Disabilities (DDD), the changes are intended to give providers the flexibility to better tailor services around the unique needs and preferences of each individual, according to Kevin Savage, the Director of Licensing at BHDDH.

On Aug. 21, before the proposed regulations were made public, Savage agreed to describe the purpose of the changes in general terms. He said he would be was prohibited from making any remarks once the public comment period opened.  That happened Sept. 6, when the proposed regulations were posted on the Secretary of State’s website. Written comments will be accepted until Oct. 6.  

An index with links to the rules proposed for adoption – and those proposed for repeal - can be found here:  https://rules.sos.ri.gov/promulgations/organization/212

On Sept. 18, the hearing schedule will be:

·         11 a.m.   Developmental disability regulations

·         1 p.m.      Licensing regulations for all entities that operate under the auspices of BHDDH

·         3 p.m.    Behavioral healthcare regulations

 

The regulations are part of a broader context that includes standards of quality which developmental disability service organizations must meet to obtain and keep an operating license.

                                                    

Until now, the standards of quality have been part of the regulations, which carry the force of law. But Savage, the BHDDH licensing director, has said that arrangement stifles the flexibility of providers to tailor services to the needs of individuals.

 

In the proposal, the standards of quality, or “certification standards” would no longer be part of the regulations, but instead serve as guidance about what organizations must do to become licensed or have their licenses renewed. (links to standards.)

 

 

 

xxxxxxThe regulations are part of a broader context that includes standards of quality which developmental disability service organizations must meet to obtain and keep an operating license.                                                     

Until now, the standards of quality have been part of the regulations, which carry the force of law. But Savage, the BHDDH licensing director, has said that arrangement stifles the flexibility of providers to tailor services to the needs of individuals.  

In the proposal, the standards of quality, or “certification standards” would no longer be part of the regulations, but instead serve as guidance about what organizations must do to become licensed or have their licenses renewed.

Long-awaited revisions to regulations governing Rhode Island’s services for adults with developmental disabilities, as well as those for behavioral healthcare, substance abuse prevention and treatment and state hospitals, have been posted by the Secretary of State’s office and are to be discussed in public hearings Tuesday, September 18, at the Arnold Conference Center in Cranston.

A link to new and old regulations is in the “What’s New” section of the website of the state Department of Behavioral Healthcare, Developmental Disabilities and Hospitals.

The first hearing, on rules and regulations for developmental disability service providers, is scheduled at 11 a.m. At 1 p.m., the discussion will shift to the licensing of all service providers and facilities that are funded by BHDDH. And at 3 p.m., there will be a hearing for rules and regulations governing behavioral healthcare organizations.

Written public comment will be accepted until Oct. 6.

RI DD Regulatory Overhaul To Emphasize Transparency; Quality Services, Officials Say

By Gina Macris

When proposed new regulations for Rhode Island’s Division of Developmental Disabilities (DDD) emerge from committee early in 2018, they will aim to ensure that all agencies providing services to persons with disabilities meet consistent high-quality standards.

The state will require direct care agencies to employ staff with distinct certifications to provide one or more kinds of supports to clients. Training of agency workers is expected to follow the same process that is now required before direct care staff can work in a pilot job support program run by DDD – a  combination of classroom instruction, field work, and a final exam. 

But workers will not be expected to have certification the moment the new regulations go into effect. Expanding the training process begun for workers in the supported employment pilot program will take time, said Kerri Zanchi, director of DDD.

Another feature of the new regulations will require DDD to publish the categories of licenses held by direct care providers. They are: 

  • “Full,” or unrestricted
  • “Full, with stipulations”
  • “Provisional”, to designate a new service provider
  • "Conditional”, or probationary
  •  “Suspended,” which means not currently in operation, but the license has not been revoked.

Zanchi and Kevin Savage, the director of licensing for the division’s parent organization, the Department of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH),talked about the overhaul of regulations during a wide-ranging public forum at the Smithfield Senior Center Nov. 7 and in an earlier interview with Developmental Disability News Nov. 3.

The Division of Developmental Disabilities is not alone in rewriting its regulations.

All agencies of state government must recast their rules of operation by August, 2018 with an eye toward simplicity and clarity of language as part of the Administrative Procedures Act of 2016, pushed by Governor Gina Raimondo in a drive for greater transparency in state government.

Even before the regulations are finalized, Savage said in the interview Nov. 3, he hopes to have licensing categories for all developmental disability service providers posted on the BHDDH website.

The proposed regulations have emerged from six months’ work on the part of a broad-based committee of individuals with a stake in the developmental disability system, including consumers and family members, Savage told an audience of about 75 at the public forum in Smithfield Nov. 7.

“The community was well served by this process. It was amazing,” Savage said.  Representatives of different segments of the developmental disabilities community listened to each other and showed “passionate concern with the people being served,” he said.

The proposed regulations will be shared with the developmental disabilities community before they go out for formal public comment, Savage said. Community meetings will be set for early 2018, after the year-end holidays, he said.

Among other things, the new regulations will help eliminate inconsistencies across departments of state government, Savage said, like background checks for prospective workers who would come into contact with vulnerable children and adults in a variety of capacities.  The regulatory reform also is necessary to comply with the so-called Final Rule for federal/state Medicaid Home and Community-Based Services (HCBS).  The Final Rule, a compilation of federal regulations, emphasizes that all persons with disabilities who receive Medicaid services must have access to their communities to the greatest extent possible.

Both the HCBS final rule and a separate 2014 federal consent decree pushing  employment opportunities and community-based non-work activities for Rhode Islanders with developmental disabilities get their authority from the 1999 Olmstead decision of the U.S. Supreme Court. The decision clarified the integration mandate in Title II of the Americans With Disabilities Act.

Zanchi, the DDD director, said that the regulatory shift toward certification of the skills of direct care workers is partly driven by U.S. District Court oversight of the Olmstead consent decree, in which an independent court monitor has emphasized continuous quality improvement.

“The public will know what the providers are certified to do,” Zanchi said in the interview Nov. 3. “And that’s part of our quality management plan.”

“That will be hard work,” she said. “We will build certification standards in each area, starting with day and employment services.”

In the future, the whole notion of certification is likely to overlap with fiscal discussions about low wages and high turnover in the field of direct care, where one job in six goes vacant, according to a trade association of developmental disability service providers.

The pilot program in supported employment requires certification for workers who provide services in job development, job coaching and the like. But the graduation rate from a tuition-free training program at the Sherlock Center on Disabilities at Rhode Island College so far has been about 40 percent, for a variety of reasons, according to a Sherlock Center official.

Future of RI Fedcap Agency Still Unclear; State Continues To Collect Evidence For Final Decision

By Gina Macris

With less than two months remaining before the state of Rhode Island decides whether to shut down a subsidiary of the New York-based Fedcap Rehabilitation Services, licensing officials at the Department of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH) are still collecting evidence that will have a bearing on the state’s decision.

The performance of Community Work Services (CWS), which also has come under criticism by federal officials, is expected to figure in a U.S. District Court hearing Nov. 30 about a 2013 settlement of disability rights violations involving CWS and its predecessor, the now-defunct sheltered workshop Training Through Placement (TTP.)

In an interview Nov. 3, the director of licensing for BHDDH, Kevin Savage, said that the probationary status of CWS, in effect for nearly a year, “has not been resolved.”  Licensing regulations place a 12-month limit on probation.

 A federal court monitor said during a court hearing in May that the number of former TTP clients who had found jobs had been “essentially flat” for the previous four years. A lawyer for the U.S. Department of Justice also cited a lack of progress that was evident during a site visit earlier in the spring.  About half of individuals protected by the 2013 agreement – 62 individuals at last count – are currently served by CWS.

In an interview Nov. 3, Savage, the BHDDH licensing administrator, said that the most recent "monitor’s report is primarily about the programming, and the programming issue is not resolved.

“We’re reading the monitor’s reports and our own reports,” Savage said, and “we are not satisfied with the program resolution.”

Savage said that BHDDH will continue – “and I want the word 'continue' to be clear” – to look at “every aspect of what CWS does, including payment structures, including respite (care), and including how they work with families and participants – everything.”

Savage also said, “I think it’s okay to say we are accumulating evidence. They (CWS) know that, and I think it’s okay for the public to know that. The evidence speaks to whether they should be shut down, or whether they should not be shut down. Evidence does that.”

“Our goal, and our only goal, is to ensure that participants have the best service available that is possible,”  he said. “We’ve communicated that clearly to the providers we work with and the families we work with. Our job is not to protect businesses. Our job is to protect participants.”

CWS has been on probation since the beginning of 2017. BHDDH licensing officials shut down its operation at the former TTP building at 20 Marblehead Ave., North Providence, in March because of unsafe conditions - a problem separate from programmatic concerns - but the agency re-opened with state permission in different quarters a few days later.

In this and any other probationary case, Savage said, the public has the right to know the “final agency action.”  Adverse decisions may be appealed by the agencies in question, he said.

The performance of CWS is entwined in the state’s accountability to the federal court for satisfying the demands of the 2013 settlement agreement that protect special education students at Mount Pleasant High School, including the former Birth Academy, and former clients of TTP - a total of 126 individuals.

A broader agreement between the state and the DOJ signed in 2014 covers all adults with developmental disabilities who have at one time been segregated in either sheltered workshops or day centers - more than 3,000 people. .

In connection with the so-called  "Interim Settlement Agreement" of 2013, the federal court monitor, Charles Moseley, said in a report to the court in September that the state has missed two deadlines in an order issued by Judge John J. McConnell, Jr: They are

  •  A July 30 deadline for improving the quality of individual career development plans among CWS clients.
  • A June 30 deadline for verifying the accuracy of data reported by CWS on its clients’ progress.

So-called “career development plans” describe how current services and plans for the near future fold into blueprints for life-long work goals that are supposed to take into account both the needs and preferences of individuals with developmental disabilities.

The November 30 hearing is listed on the U.S. District  Court calendar in connection with the statewide 2014 consent decree, but the state's interim Consent Decree Coordinator, Brian Gosselin, said recently at a public forum on developmental disability issues that the session will deal instead with the more narrow Interim Settlement Agreement of 2013, which was last heard in late May. A separate hearing on the status of the statewide consent decree is expected to be scheduled for the end of January, six months after its most recent hearing in late July.