{"report_id":213,"form_id":"23","user_id":81,"organization_id":10,"question_id":"100","question_type":"Free_Text","text_answer":"The services being terminated for a person due to concerns for staff safety were impacted by increased staff injuries. The physical aggression displayed by the person was increasing, which led to the increased staff injuries and the person damaging the house. Staff were not always able to be consistent when redirecting behavior with just one staff which impacted the increased staff injuries. The pressure from the worker\u2019s compensation agency influenced the services terminated due to the concerns for staff safety. The number of workman\u2019s comp claims influenced the pressure from this agency, which was impacted by the increased injuries to staff.\r\n\r\nStaff injuries was also influenced by the staff being unable to consistently redirect behaviors with one staff. One of the impacts to the inconsistency in redirecting behaviors, which included physical aggression, property distruction and self injurious, was the physical layout of the house due to narrow hallways and bathroom made it difficult to give space or intervene so the way staff chose to intervene was dependent on where the staff and individual were physically at in the home at the time of the behavior.The physical layout of the house not only impacted the consistency of redirecting these behaviors, but this also directly impacted the increased staff injuries and the requests to develop a new site around the person\u2019s sensory needs. This request was subsequently denied by the county due to the county being unaware of available funds for modification for new development and that the county had limited foster care development. The limited foster care development was influenced by the county having a high number of foster care homes serving individuals from other counties along with a statewide moratorium on the creation of foster care beds, which in essence was a hold in developing further beds. This moratorium not only limited the foster care development in the county, but it also impacted the elimination of institutions in the state and left few alternative housing options. Other influences of the elimination of institutions was the Jensen Settlement and the Minnesota Olmstead Plan which found that individuals with disabilities were unconstitutionally secluded and the plan detailed a way to ensure that individuals with disabilities live in the most integrated setting appropriate for their needs. Another impact of staff being unable to consistently redirect behaviors with one staff was the staffing level dropped in the home in 2017 after a roommate passed away. When the person passed away, the home reduced their staff level to coincide with the reduced reimbursement that came from that person\u2019s residence in the home. The staff attached to the roommate who passed away would often intervene in de-escalating and responding to the person\u2019s physically aggressive behavior. When the roommate passed away, the provider inquired about adding a staff but were told that 2:1 staff couldn\u2019t be reimbursed. This was impacted by the county not moving forward with the rate exception due to the needs of the person not changing, which in turn was influenced by the banding for the state rate allowing limited rate increase for service intensity. The Disability Waiver Rate System (DWRS) has impacted the banding requirements. The last impact to the staff being unable to consistently redirect behavior with one staff was the difficulty in matching staff to the needs of the people in the home. The difficulty in matching staff was influenced by the person tending to work best with male staff (2 particular staff) but also the low applicant pool fitting the person\u2019s preference.  The low applicant pool was influenced by the current workforce shortage in the community and state. \r\n\r\nThe attempts and barriers to create the right service environment were also an influence to the terminating the person\u2019s services due to concerns for staff safety. This was due to the 2:1 staff not being able to be reimbursed as previously mentioned because the staffing in the home changed but not the person\u2019s needs. It also was influenced by county\u2019s denial of the request to develop a new site around the person\u2019s sensory needs. Subsequently, previous attempts to terminate service were not followed through on due to lack of providers which was impacted by the view that a part of the continuum of care for people with challenging behaviors statewide is missing. This missing part of the continuum is influenced by the lack of crisis respite providers, a lack of service availability between crisis residential services and hospitals, and few services for adults with autism. The effort to eliminate institutions and the DWRS has impacted the missing part of the continuum. The goal of the elimination of institutions to promote community living is generally seen as good; however, the lack of alternatives is what is most problematic to serve this population.","created_by":81,"updated_by":81,"updated_at":"5\/25\/2021 10:22:02 am","created_at":"5\/25\/2021 10:22:02 am","id":15755}