Olmstead Data Collection Tool - Division of Disability, Aging and Rehabilitative Services
Target Population Served (complete a separate form for each population):
- Please indicate the target population served by your agency:
Individuals with developmental disabilities. Most are 18 and over and are no longer enrolled in school.
The number of individuals with developmental disabilities who are served in Indiana’s institutions is estimated to be roughly 6820. A total number of individuals receiving Medicaid reimbursement for services in the community is 4396.
- Please outline/describe the array of services provided to the aforementioned target population:
Services range from services in the state developmental centers (most restrictive) to services in large private ICFs/MR, to group homes, waiver services and state supported community-based services. Some individuals with developmental disabilities are in nursing homes.
Types of services typically found (but not limited to) all waiver programs include:
- Case management, services including arrangement of the provision of services, service coordination, crisis intervention, case planning, follow along to ensure quality improvement.
- Case management assessment including assessment and referral, re-assessment when necessary.
- Personal assistance/attendant care.
- Respite care.
- Adult day care.
- Residential-based habilitation.
- Day habilitation which may include provision of meals and snacks, personal assistance with daily living skills and supervision, medical care, transportation, counseling.
- Prevocational services.
- Supported employment.
- Environmental modifications such as lifts or ramps, grab bars, widened doors.
- Assistive technology.
- Personal emergency response system.
- Physical therapy.
- Occupational therapy.
- Speech/language therapy.
- Transportation to and from appointments/outside activities in the plan of care for each recipient.
- Please indicate the statutory authority (federal and/or state) of each target population served by your agency:
42 USC 1396 (Medicaid: both waivers and ICF/MR services)
IC 12–10 (waivers) and IC 12-11 (Bureau of Developmental Disabilities Services)
- Please indicate the total number of consumers (by target population categories) served by your agency:
These numbers of MR/DD individuals broken out come from the program areas (BDDS/Aging and In Home Services/OMPP/DMH and are as follows: (All of the following data has dates to identify numbers to date.)
Individuals in SDCs (FWSDC and MSDC) 634 (8/22 from SDC Weekly Report)
Individuals in large, private ICFs/MR 835 (11 facilities; ISDH/LTC 8/24)
Individuals in group homes 3795
Individuals in state hospitals 2225
Individuals in nursing homes 4396 (from OMPP 8/25)
Individuals receiving waivered services:
Traumatic Brain Injury 65
ICF/MR Waiver 2158
Autism Waiver 916
ICLB 3315
Medically Fragile Children 125
- Please indicate the funding source and cost (per consumer) of each of these services provided by your agency:
Costs per consumer and funding sources are identified as follows:
ICF/MR – small group homes
SFY-2000 - $205,053,178.00
As of 7/2000 - $11,437,099.00
Per recipient - $3,468.94
ICF/MR – Large Private
SFY- 2000 - $37,851,024.00
As of 7/2000 - $2,765,055.00
Per recipient - $4,133.12
ICF/MR – State
SFY-2000 - $52,439,153.00
As of 7/2000 - $3,557,527.00
Per recipient - $8,370.65
- Please describe how consumer choice is considered in determining the appropriate placement of each consumer served by your agency:
For those individuals receiving services in the community, a person-centered plan is developed for the individual. Person centered planning is being done for each individual residing in a state developmental center. Person-centered planning has yet to be done on a large-scale basis for those residing in large private ICFs/MR, group homes or nursing homes.
- What data is collected to insure quality services are provided to the target population?
Quality improvement mechanisms are currently in place in each SDC. Each SDC currently has a Risk Management Review Committee which analyzes, on a monthly basis, incident/injury trends data, identified high-risk consumer data, and monthly outcome reports reflecting data gathered for each identified quality indicator in place. The purpose of each SDC’s quality improvement/risk management program is to ensure all safety and support provisions are optimally implemented and maintained. Another vital purpose of these Committees is to guarantee the implementation of systemic interventions and to make corrections that respond to potential and actual incidents that compromise health and safety standards. These Committees are set into place to continually strive to promote maximization of consumers’ quality of life by tracking data, identifying patterns and finding appropriate resolution to adverse individual incidents/events.
There are currently in place a number of Quality Improvement techniques addressed and utilized in each community program. These QI efforts support all community program activities conducted that are in place to enhance the quality of life of each individual deemed a consumer of DDARS services. DDARS provides a commitment of assuring that both the quality of services and the safety of each individual participating in community programs are carried out in the least restrictive, safest and most appropriate setting as possible.
In the community setting, policy of DDARS’ programs dictate that nay concerns regarding abuse or neglect are appropriately handled through referral to Adult Protective Services, Child Protective Services or are handled by resolving concerns of risk management through the BDDS Incident-Event reporting system (a requirement of DDARS/BDDS programs) to ensure that all significant issues regarding risk management (the health and safety of individuals) are brought to the attention of support and executive staff of DDARS. In some way, all critical incidents and those lesser significant events/incidents involving consumers, (those indicating a negative trend/history analysis and or those that are considered to be red-flagged issues) are addressed immediately by DDARS executive/support staff. Several other internal processes exist within BDDS and are utilized to assure quality improvement. Examples include:
- The requirement of each provider to have an approved application for certification on file.
- The requirement of each provider to have their own internal QI system in place.
- A system in place that requires independently contracted diagnosis/evaluation information for each consumer.
- Required information regarding the quality of life as regards deinstitutionalized consumers who receive services out in the community (data from the Center for Outcome Analysis).
- Annual review by OMPP staff regarding LOC and other identified problem areas as determined by case managers and other BDDS staff.
- A system in place with DDARS/BDDS that has staff who serve as quality monitors whose job it is to investigate, follow-up on problems/incidents and provide some sort of resolution to each situation.
- A system in place which requires on-going training for field staff in reporting protocol (investigative procedures), assessment and use of proper documentation to ensure resolution.
In summary, quality improvement systems are in place and functioning in both the community and in State Developmental Centers throughout the state. These systems are now being monitored through the Quality of Life (QoL) Unit of DDARS. A draft business plan (to determine how QoL does business internally) has been submitted for consideration by Alex Braitman.
- Please indicate any services that are not provided statewide (list geographic region):
All services are provided statewide.
- Please describe any measures taken (for each target population) by your agency to prevent unnecessary institutionalization:
Measures taken which prevent unnecessary institutionalization include adherence to the comprehensive plan (issued July, 1998) for the design of services for Indiana residents who are diagnosed with MR/DD. 317 Task Force recommendations include the following:
- Implementation and improvement of person centered planning and person centered funding designs for all persons with developmental disabilities served by FSSA/DDARS.
- Routinely provide individualized service planning for all persons with MR/DD based on functional assessment.
- Assure resources follow individuals and utilize all possible funding sources.
- Provide options in services and choices.
- Support exploration of options and help make better choices.
- Eliminate systemic barriers in community living and employment options.
- Utilize outside resources to analyze data.
- Redirecting funding away from congregate settings to those integrated residential, day services and employment settings based on the choices of individuals/families and the principles of person centered planning.
- Redirect funding from congregate settings to individualized, supported living arrangements.
- Redirect funding from congregate employment and day services to individualized supports in typical businesses and community settings.
- Redirect funding streams and processes to early intervention and family supports.
- Assure and improve the quality of services delivered to individuals with developmental disabilities.
- Directly involve identified MR/DD individuals and families with QA/QI processes.
- Implement an automated data system that provides continuous information relating to the quality of life outcomes for services provided.
- Re-define the roles and relationships of case managers, government and providers in assuring quality.
- Assure a system of resources for crisis intervention and protective services to individuals in their homes.
- Build the community capacity to provide individualized and person centered services in typical community settings across Indiana.
- Develop capacity and provide supported living options in all community settings.
- Offer training and technical assistance to community providers on best practices.
- Expand community capacity related to crisis intervention.
- Provide training on leadership and choice making and invest in self-advocacy.
- Secure financial resources to respond to the demand for services of persons with developmental disabilities and their families.
- Seek additional funding to stabilize the current funding system (long range funding plans for expansion of access to services).
- Funding spent in response to actual needs and analysis and continuation of services for those already in the system.
- Please describe any measures used to evaluate the current level care (e.g. deinstitutional efforts) for each consumer served by your agency:
Measures for the evaluation of current level of care for waiver program includes annual external review by OMPP staff regarding LOC changes that may have occurred during the past fiscal year. Another assessment tool used to evaluate current LOC is the yearly internal assessment of each person’s individual treatment plan that is completed by DDARS field staff and/or SDC staff to identify any changes in the LOC.
- Please describe any transition services (including any barriers/gaps) provided to the target population by your agency:
Waiting lists are long. Until 317 funds were made available funding has been tight. Provider capacity in the community is being quickly reached or has been reached.
- Please list any needs assessments that have been conducted during the previous three (3) years of this target population:
- SOF Council needs assessment that includes information which has been retrieved from public hearings and subcommittees’ analyses of information resulting in recommendations from data retrieved from involved agencies as DMH and ISDH.
- Public Law 245 (1997) – SB 317 5/6/97 – mandates that information (from analysis of data from different sources) be given each year for consideration of changes in the MR/DD programs in DDARS. The Commission was required by this law to "review and make recommendations regarding any unmet need for mental retardation and developmental disability services." As well, the Commission "shall submit its findings and initial recommendations to the governor and the general assembly by 12/1 of each year. This section of the law expires January 1, 2001.
- Please provide a brief summary of the priorities, barriers, and assets identified by the aforementioned needs assessment.
None
- Implementation and improvement of person centered planning and person centered funding designs for all persons with developmental disabilities served by FSSA/DDARS.
