Tennessee works to improve oversight of facilities for people with disabilities

From the Jackson Sun in Tennessee:

The state's Division of Intellectual Disabilities Services has partially expanded its investigation of abuse and other incidents and is working toward monitoring training at certain private facilities that care for people with mental disabilities.

The facilities, known as intermediate care facilities, are designed to care for the frailest and most profoundly mentally disabled people. An investigation by The Jackson Sun that was reported in April discovered that Intellectual Disabilities Services had not collected the training reports for most of this decade or attempted to remove the requirement from TennCare payment agreements with care agencies.

Leaders from the agency, which was formerly called the Division of Mental Retardation Services, said earlier this year they were not aware the reports were part of the TennCare agreement despite being urged to begin collecting the information by an agency task force in 2007.

Missy Marshall, an Intellectual Disabilities Services spokeswoman, said the agency was trying to determine the format and information to be included in the reports, neither of which are addressed in the TennCare agreement.

She said agency officials are working with the state's Departments of Health and Mental Health and Developmental Disabilities, which also oversee intermediate care facilities, to gauge how they monitor staff training at the facilities.

"The goal here is to determine if a comparative analysis of our reports with their reports might enhance oversight," Marshall said in an e-mail.

Marshall said the agency took over investigation of incidents such as abuse and neglect at private intermediate care facilities in East Tennessee this fall and plans to do so in Middle Tennessee in early 2010. The agency began investigating incidents at West Tennessee facilities in 2008.

The division's investigations of these facilities are considered stricter and more thorough among advocates and administrators of mental disability care. They probe incidents ranging from physical and mental abuse to accidents and fights among those who live at intermediate care facilities.

Mental Health investigators were primarily in charge of such investigations at intermediate care facilities prior to the switch. The Jackson Sun found earlier this year that Mental Health officials rarely investigated such incidents in-person, relying largely on phone interviews and on the findings of investigations led by facility personnel. Mental Health officials defended those efforts, saying they are careful and deliberate in how they spend state money.

One West Tennessee facility, the Winfrey Center in Trenton, had at least 13 substantiated complaints of abuse and neglect between January 2006 and late March 2009. Between March and early December, there were 12 additional substantiated abuse and neglect complaints.

The facility's management, bookkeeping and patient care also have received poor marks from a federal court monitor who was assigned to survey the facility in 2007.
Officials from Developmental Disability Management Services, a Collierville company that manages Winfrey, have pinned the poor reviews of their facility on the company's difficulty in attracting sensitive, higher-quality employees because of the low pay and difficulty of their field. They have said they think a planned redistribution of Winfrey's population to an array of new group homes in residential areas in Gibson and Madison counties should improve the treatment of the residents in their care.

State officials have denied requests to release investigative reports on incidents at Winfrey, citing privacy protections for the mentally disabled in state law.

Intellectual Disabilities Services, part of the Department of Finance Administration as a result of 1990s lawsuits aimed at remedying poor care for the mentally disabled, is again in something of a transition period. The agency's longtime leader, Deputy Commissioner Stephen Norris, retired in the fall.

The state legislature also renamed the agency this year to be more sensitive to those whom it oversees.

Gov. Phil Bredesen said at a November budget hearing that cutting state aid for a few hundred mentally disabled people must be considered in the midst of the state's latest financial crunch. Intellectual Disabilities Services also has shed staff - many related to the eventual closing of Arlington Developmental Center in Memphis - and the agency plans to end the Family Support Program, which provides aid to those with a wide range of disabilities, in June.

Bredesen, who noted at the budget hearing that he did not know of the agency's name change before the meeting, said that he understands the great needs of Tennessee's mentally disabled. But he said that many cuts must be considered in light of other potential cost-savings measures such as the early release of prisoners.

Discussing how much Tennessee spends on such services compared with other states, Bredesen and Intellectual Disabilities Services officials also said there is likely an unreasonable expectation for the quality of care in Tennessee because of two decades of litigation against the state over poor treatment of the mentally disabled.

They discussed cost-saving efforts to cut down on the number of mentally disabled people who receive expensive, in-home, single-person care by having those who receive such help take on roommates.