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1 Washington State Department of Social & Health Services
Don Clintsman, Assistant Director Division of Developmental Disabilities Aging & Disability Services Administration Department of Social and Health Services September 6, 2012
Residential Habilitation Centers Developmental Disabilities Services System Task Force
2 Washington State Department of Social & Health Services
Today’s Discussion
• Major influences on the DDD System • RHC and community services • New community services being developed • Costs • National Data • Long term considerations
3 Washington State Department of Social & Health Services
• Entitlements • Discretionary services • Responsiveness to need • Financial factors
Influences on the DDD system
4 Washington State Department of Social & Health Services
DDD Caseload
18,045 50%
897- 2%
11,585 32%
5,884 16%
44, 0%
No Paid ServicesRHCWaiver ClientsMPCIMR
Source: EMIS June 2012
5 Washington State Department of Social & Health Services
RHC Growth
1914 Lakeland – built
1939 Rainier School - built 1958 Yakima Valley – former TB hospital
1959 Fircrest School - former TB center
Frances Haddon Morgan Center 1972 Former Navy hospital
1886 – School for the Deaf/Blind established
1907 Eastern Washington Hospital
Interlake School 1967
6 Washington State Department of Social & Health Services
RHC - History
1993 Interlake 117 people
2011 Frances Haddon Morgan Center 53 people
Prior to 1993 School for the Deaf and School for the Blind transferred from DSHS
7 Washington State Department of Social & Health Services
1983-2012 Population
0
5,000
10,000
15,000
20,000
25,000
30,000
35,000
40,000
45,000
Jul 1
983
May
198
4M
ar 1
985
Jan
1986
Nov
198
6Se
p 19
87Ju
l 198
8M
ay 1
989
Mar
199
0Ja
n 19
91N
ov 1
991
Sep
1992
Jul 1
993
May
199
4M
ar 1
995
Jan
1996
Nov
199
6Se
p 19
97Ju
l 199
8M
ay 1
999
Mar
200
0Ja
n 20
01N
ov 2
001
Sep
2002
Jul 2
003
May
200
4M
ar 2
005
Jan
2006
Nov
200
6Se
p 20
07Ju
l 200
8M
ay 2
009
Mar
201
0Ja
n 20
11N
ov 2
011
All DDD client
Community Residential RHC
Source: EMIS July 1983 June 2012 All DDD clients 11,932 39,810
Community Residential 513 4,325 RHC long term clients 1,868
837
8 Washington State Department of Social & Health Services
RHC – Thirty Year History
2231
1844 1758
1320 1143
973 914
0
500
1000
1500
2000
2500
1980 1985 1990 1995 2000 2005 2010
Highest population was 4,147 in 1967
9 Washington State Department of Social & Health Services
Washington compared to similar states
1980 1985 1990 1995 2000 2005
2010 % change
WA 2231 1844 1758 1320 1143 973 914 59% ↓
MA 4531 3580 3000 2110 1306 1089 759 83.2% ↓
MI 4888 2191 1137 392 271 173 0 100% ↓
WI 2151 2058 1678 1341 900 590 448 79.2% ↓
MN 2692 2065 1392 610 42 29 25 99.1% ↓ Data source: Larson, S.A., et al. (2012)Residential Services for Persons with Developmental Disabilities: Status and trends through 2010. Minneapolis; University of Minnesota, Research and Training Center on Community Living, Institute on Community Integration. http://rtc.umn.ed./risp10
10 Washington State Department of Social & Health Services
RHC Data Long Term Short Term
(end of month) NF ICF/ID
Fircrest School 201 14 93 122
Lakeland Village 212 2 89 125
Rainier School 341 8 0 349
Yakima Valley 80 8 88 0
TOTAL: 866 Source: DDD Management Reports June 2012
11 Washington State Department of Social & Health Services
RHC Data Average Age
Average years of admission
Admission range
Fircrest School 49 7.4 >1 month – 28.5 years
Lakeland Village 55 35.8 years >1 month - 78.9 years
Rainier School 57 13.35 >1 month – 70 years 5 people < 60 years
Yakima Valley 48 6.74 1.2 – 7.45 years
12 Washington State Department of Social & Health Services
RHC Living
• Stand alone physical campuses • Duplex style residences • Group based activities, work and daily
routines • Have interdisciplinary treatment teams • Community services primarily used for
specialized care
13 Washington State Department of Social & Health Services
Community Living
• Own or lease own residence – one to four person homes, apartments, duplexes
• Share with one or more house-mates • Individualized activities, work and daily
routines • Community services used for professional
team, specialized care • Treatment professionals are community
based – sometimes state employees
14 Washington State Department of Social & Health Services
RHCs and Community Residential Programs – Comparison of 1:1 Programs and Single Households
Community Residential Region 1 Region 2 Region 3 Total
Individuals requiring care in a single person house-hold
with 1:1 staffing 61 99 79 239
Residential Habilitation Center Fircrest Lakeland Rainier Total
Individuals requiring 1:1 supports
25 18 30 73
15 Washington State Department of Social & Health Services
What RHCs offer • Structured programs
• Caretaking processes and systems are strong
• Physical boundaries of campuses allow some individuals independent freedom of movement
• In-house, on-site teams are advantageous for those with complicated needs.
• Capable to quickly admit and assume crisis care for families
• Facilities are closely surveyed by multiple agencies
16 Washington State Department of Social & Health Services
What community offers • Social and Physical Integration
• Permanency
• Greater Privacy in living arrangements
• More Individualized services
• Supported employment opportunities
• Customizing services around one person at a time
• Facilitates more self sufficiency for clients or families
17 Washington State Department of Social & Health Services
RHC – COMMUNITY SERVICE COMPARISONS
Services by Setting RHC SOLA SL
Accessibility Adaptations
Behavior Management & Consultation
Employment & Day Program Supports
Habilitation Services
Medical / Dental
Mental Health Crisis Diversion Bed
Nursing Services
Limited choices of provider Options of provider choice
18 Washington State Department of Social & Health Services
RHC – COMMUNITY SERVICE COMPARISONS
Nutrition & Dietary Services
Occupational Therapies
Physical Therapies
Psychiatric Services
Psychological Services
Recreational Options
Social Services Specialized Medical Equipment Supplies
Speech, Hearing & Language Services
Staff Training
Transportation
19 Washington State Department of Social & Health Services
COST COMPARISONS – Monthly costs
58,383,276 81%
13,536,529 19%
0%
COMMUNITY
RHC
Enrolled - noservice
Source: EMIS June 2012
20 Washington State Department of Social & Health Services
COMPARATIVE COSTS
$0
$1,534
$550
$2,097
$5,541
$6,509
$9,960
$15,401
Clients Enrolled, but no Services
Medicaid Personal Care
Individual & Family
Basic & Basic +
CIIBS
Core
Community Protection
Residential Habilitation Centers
Average Monthly Cost Per Client
21 Washington State Department of Social & Health Services
RHC Operating Budgets
FY 12 % Salaries 88,310,853 56% Benefits 46,108,328 29% Goods 12,117.752 7% Utilities 3,922,932 2% IMR tax 8,178,661 5% Travel 32,418 >1% Equip 1,602,100 1% Other 592,491 >1% Debt 281,478 >1% Revenue 3,644,321 NA
TOTAL 157,440,692 100%
Source: DDD Budget data
56%, 29%
6% 2% 5%
1%
1% 0
Salaries
Benefits
Goods/services
Utilities
IMR tax
Equipment
other
22 Washington State Department of Social & Health Services
Long Term Considerations
• Legal trends and implications
• Political discussions
• Financial Issues
• Person - Family Preferences
23 Washington State Department of Social & Health Services
Questions:
Don Clintsman, Assistant Director Division of Developmental Disabilities Donald.Clintsman@DSHS.wa.gov 360/725-3421
For more information, please contact:
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