{"id":187,"form_id":"23","user_id":"81","question_id":null,"organization_id":"10","tab_id":null,"question_type":null,"text_answer":"{\"Short_Answer__76\":\"CY_Mains'l-HC-2020-07\",\"Date__77\":\"07\\\/28\\\/2020\",\"Multiple_Choice__78\":\"Charles Young\",\"Short_Answer__80\":\"Mains'l Services\",\"Short_Answer__81\":\"Kelly Boser McBroom\",\"Short_Answer__82\":\"kbmcbroom@mainsl.com\",\"Short_Answer__83\":\"763-494-4553\",\"Multiple_Choice__84\":\"245D Service Termination\\\/Suspension\",\"Multiple_Choice__85\":\"Hennepin County\",\"Date__86\":\"05\\\/29\\\/2020\",\"Multiple_Choice__96\":\"1\",\"Short_Answer__91\":\"Service termination was issued\",\"True_or_False__94\":\"Yes\",\"Free_Text__100\":\"The provider issuing a person a service termination as necessary for her welfare and her needs couldn\\u2019t be met was strongly influenced by the fact that available external mental health and crisis services required a person to be in danger of losing their housing. The provider noted that they did not have an actual intention of terminating the person\\u2019s services, but instead wanted to ensure that the person could access needed mental health services. The case manager had difficulty in finding other providers to work with her due to a lack of appropriate crisis services available statewide and so requested that the provider issue the service termination to help access alterative crisis and mental health services. People with a residential placement are deprioritized on crisis service waiting lists as priority must be given to people without or in danger of losing housing. There are also few locked facilities in Minnesota, which the team thoughtT this person could need to help manage the person\\u2019s escalating elopement and physical aggression concerns. This lack of locked facilities in Minnesota is impacted by the state\\u2019s regulations that focus on providing services in a least restrictive setting, the Olmstead vs. LC lawsuit, Minnesota\\u2019s Olmstead Plan, Minnesota Statute 245D and the Jensen Settlement \\u2013 which created the need for Minnesota\\u2019s Olmstead Plan and the stronger focus on utilizing less restrictive settings. Minnesota\\u2019s Moratorium on foster care and other residential settings (ICF\\\/DDs) also prevented providers from opening settings that were sometimes seen as more restrictive settings, leaving fewer options for people who may need this type of environment. \\r\\nThe person had a primary diagnosis of developmental disability, which exempted her from accessing some of the mental health services the team thought she needed, such as IRTS \\u2013 which will only serve people with an MH diagnosis. Due to the confusion and\\\/or disagreement among professionals involved with this person regarding whether the person\\u2019s interfering behavior was psychiatric or behaviorally based, obtaining a specific diagnosis was difficult. MA doesn\\u2019t allow for multidisciplinary assessments, so her team was not able to meet and work out a specific diagnosis or plan. Some professionals diagnosed her as primarily having a developmental disability (neurocognitive disorder) while others diagnosed her as primarily having a mental health disorder. Shortly before the termination was issued, one clinician diagnosed her with a primary mental health disorder, which the professional saw as primarily contributing to the person\\u2019s escalating and dangerous interfering behavior.  The person\\u2019s primary diagnosis couldn\\u2019t be resolved amongst the professionals, impacting the person\\u2019s inability to access mental health services. \\r\\nThe provider issuing a person a service termination as necessary for her welfare and her needs couldn\\u2019t be met was influenced by the person\\u2019s interfering behavior which was escalating and dangerous. The person regularly physically aggressed towards her roommates and staff. The other people in the home were considered vulnerable, and the provider has a responsibility to safeguard the health and safety of all residents \\u2013 as well as their staff. This responsibility is assigned to providers by Minnesota Statutes 245D, the statute governing an HCBS provider\\u2019s license. The responsibility is also assigned to providers by the Coordinated Service and Support Plans created by lead agency or contracted HCBS case managers. Along with endangering the other people in the home, the person also trespassed routinely on neighbor\\u2019s property and even their homes and called 911 often. Due to these 911 calls, the person was transported to the hospital often but rarely admitted. It was determined through a functional behavior assessment that the person enjoyed going to the hospital and receiving attention from the EMTs and hospital staff. This desire led to the person often falsely reporting medical concerns to the 911 dispatchers. When it was determined that the person didn\\u2019t have an actual medical concern, the hospitals and EMT would discharge or refuse services because they won\\u2019t serve someone in crisis if the underlying cause is \\u201cbehavioral\\u201d rather than medical. MA rules require hospitals to provide care if a person is a danger to themselves or others, and the medical professionals felt that the person\\u2019s issues were attention-seeking in nature and not a serious health or mental health concern. When the person eventually could not access medical and EMT services due to her false reporting, she started calling on issues that law enforcement would typically respond to. Her behavior escalated to eloping from the home and laying in the road despite oncoming traffic. Due to her size, staff were unable to move or remove her from this position without law enforcement assistance. The law enforcement officers involved reportedly eventually grew frustrated responding to issues they thought the residence should handle, and refused to work with the person.\\r\\nThe interventions that were implemented with the person by the provider appeared to not be effective. The provider\\u2019s philosophy was to avoid restrictive interventions such as restraint or rights restrictions. Because of the person\\u2019s demeanor and size, the provider also didn\\u2019t think restrictive interventions would safely resolve the person\\u2019s interfering behavior. This philosophy to avoid restrictive interventions was influenced by person-centered philosophy\\\/ethics, as well as the requirements in the licensing statute MN Stat. 245D. Those interventions that were tried, such as positive support strategies and even increasing the person\\u2019s staffing to 1:1 did not decrease the incidence and intensity of the person\\u2019s interfering behaviors. The person had a person-centered plan created with them, and in that planning process it was determined that the person wanted to live alone, something the provider tried to work with the person to help them work towards a more independent placement. But the fact that the person wasn\\u2019t living in a preferred setting was believed to contribute to the person\\u2019s escalating interfering behavior. The provider requested support in the area of mental health training and staffing, but these services were either unavailable or not as intense as the provider was seeking. This lack of services was influenced by lower wages and compensation for these services. These lower wages were seen as lower than needed due to a statewide workforce shortage that increased the demand for staff which, in turn, increased the wages in other service sectors so that HCBS services were less desirable for workers. HCBS rates are mainly determined by Minnesota Statutes governing the Disability Waiver Rate Setting requirements. Creating higher wages\\\/HCBS reimbursement required action by the Minnesota Legislature. \\r\\nThe provider was pressured to act in this situation due to the escalating and dangerous behavior and the neighbor\\u2019s concerns about their own welfare and placing pressure on the provider to prevent the behaviors and pressure from law enforcement to act. While the provider didn\\u2019t intend to actually terminate services, it appeared as though the only way to access needed crisis and mental health services for the person was to issue a service termination.\",\"Multiple_Choice__103\":\"2\",\"Free_Text__104\":\"The provider requested support in the area of mental health training and staffing, but these services were either unavailable or not as intense as the provider was seeking. This lack of services was influenced by lower wages and compensation for these services. These lower wages were seen as lower than needed due to a statewide workforce shortage that increased the demand for staff which, in turn, increased the wages in other service sectors so that HCBS services were less desirable for workers. HCBS rates are mainly determined by Minnesota Statutes governing the Disability Waiver Rate Setting requirements. Creating higher wages\\\/HCBS reimbursement required action by the Minnesota Legislature.\",\"Multiple_Choice__115\":\"3\",\"Free_Text__116\":\"The provider issuing a person a service termination as necessary for her welfare and her needs couldn\\u2019t be met was influenced by the person\\u2019s interfering behavior which was escalating and dangerous. The person regularly physically aggressed towards her roommates and staff. The other people in the home were considered vulnerable, and the provider has a responsibility to safeguard the health and safety of all residents \\u2013 as well as their staff. This responsibility is assigned to providers by Minnesota Statutes 245D, the statute governing an HCBS provider\\u2019s license. The responsibility is also assigned to providers by the Coordinated Service and Support Plans created by lead agency or contracted HCBS case managers.\",\"Multiple_Choice__119\":\"3\",\"Free_Text__120\":\"The provider issuing a person a service termination as necessary for her welfare and her needs couldn\\u2019t be met was strongly influenced by the fact that available external mental health and crisis services required a person to be in danger of losing their housing. The provider noted that they did not have an actual intention of terminating the person\\u2019s services, but instead wanted to ensure that the person could access needed mental health services. The case manager had difficulty in finding other providers to work with her due to a lack of appropriate crisis services available statewide and so requested that the provider issue the service termination to help access alterative crisis and mental health services. People with a residential placement are deprioritized on crisis service waiting lists as priority must be given to people without or in danger of losing housing. There are also few locked facilities in Minnesota, which the team thoughtT this person could need to help manage the person\\u2019s escalating elopement and physical aggression concerns. This lack of locked facilities in Minnesota is impacted by the state\\u2019s regulations that focus on providing services in a least restrictive setting, the Olmstead vs. LC lawsuit, Minnesota\\u2019s Olmstead Plan, Minnesota Statute 245D and the Jensen Settlement \\u2013 which created the need for Minnesota\\u2019s Olmstead Plan and the stronger focus on utilizing less restrictive settings. Minnesota\\u2019s Moratorium on foster care and other residential settings (ICF\\\/DDs) also prevented providers from opening settings that were sometimes seen as more restrictive settings, leaving fewer options for people who may need this type of environment.\",\"Yes_or_No__432\":\"Yes\"}","mcq_answer":null,"other_answer":"0","status":"1","created_by":"81","updated_by":81,"created_at":"5\/24\/2021 7:44:26 pm","updated_at":"6\/11\/2021 1:59:13 pm","deleted_at":null,"report_name":"CY_Mains l - HC -2020 -07"}