The New Virginia Way

7/30/2019 The New Virginia Way

1/24

The new Virginia way >


2/24

The Arc f Agsta

The Arc f Central Virginia

The Arc f Eastern Shre

Hanver Arc

The Arc f Harrisnbrg & Rcingham

The Arc f Lenwisc

The Arc f Ldn

The Arc f Martinsville & srrnding

cnties f Henr, Patric & Franlin

9 The Arc f New River Valle

10 The Arc f Nrth Central Virginia

11 The Arc f Nrthern Shenandah Valle

12 The Arc f Nrthern Virginia

13 The Arc f the Piedmnt

14 The Arc f Greater Prince William

15 The Arc f Rappahannc

16 Greater Richmnd Arc

17 The Arc f Greater Rane Valle

18 The Arc f Rcbridge

19 Arc Smth Cnt

20 The Arc f Sthern Virginia

21 The Arc f Sthside

22 The Arc f Sth Hamptn Rads

23 The Arc Sth f the James

24 The Arc f Warren Cnt

25 The Arc f Greater Williamsbrg

26 The Arc f the Virginia Peninsla

26

222021

1

18

10

117

17

12

3

16

25

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196

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at T ac V

The Arc o Virginia is the state chapter o The Arc o the United States, the nations oldest and larges

organization o and or people with intellectual and developmental disabilities (ID/DD). The Arcs

mission is to promote and protect the human rights o people with ID/DD and actively support their

nclusion and participation in the community throughout their lietime.

The Arc o Virginia is comprised o 26 local chapters around the Commonwealth, whose members

nclude people with ID/DD, amily members, advocates and concerned citizens. The Arc advocates or

all people with ID/DD, regardless o age, diagnosis or complexity o support needs. This includes tho

who live in the community, as well as those who live in institutions.

ConTenTs

3 >>Abt The Arc f Virginia & Intrdctin

6 >>The New Virginia Wa & The Call T Actin

11 >>The Waiting List Crisis

12 16>>Imprving Integratin In ID/DD Waiver Services

17 18>>Settlement Agreement & Natinal Trends

19 23>>Virginias Transitin T A Cmmnit Sstem


3/24

inTroduCTion

The Arc o Virginia thanks Governor

McDonnell and the Virginia General

Assemblyor the actions that have been taken

to help Virginia transition to a community-bas

system o support or all people with intellectu

and developmental disabilities (ID/DD). This

transition will help the Commonwealth protec

civil rights, achieve sustainability and serve

more people with ID/DD in a better way.

ID/DD services are, and always have been

core service o state government.

One o Virginias earliest responsibilities was

provide care or its citizens with ID/DD. In tho

days, services were provided in an institutiona

setting. Virginia has since moved to a ocus on

community-based support.

While progress has been made, there is st

work to do.Virginia must ensure that all peo

with ID/DD, regardless o the complexity o th

needs, have access to integrated, community-

based services. Further action is also required

to address the ID/DD Waiver waiting list crisis

Funding and regulations should incentivize

and promote integrated services that maximiz

natural supports and result in real lives. It all

comes down to A Lie Like Yours, a home, a

and a lie in the community.

We have a historic opportunity to redefne

our service system, but it begins with the

policies and legislation we act on today.The Arc o Virginia urges all people connected

to Virginias ID/DD services to support the

principles oThe New Virginia Way in our

policies, legislation and program development

Now is the time to implement the

The New Virginia Way.


4/24

What Does It Look Like?

The new Virginia way

The recently approved U.S. v. Virginia

ettlement agreement provides a great

ramework to support The New VirginiaWay, but it takes work to make it happen.

The inormation that ollows will provide

an overview o issues that require attention

and immediate action.

The New Virginia Way ensuresthat all people with ID/DD, including

those with the most complex needs,

have access to truly integrated,

community-based services.

PrinCiPles of

The New Virginia Way:

The New Virginia Way emphasizes

and promotes competitive

employment, integrated housing,

meaningul relationships and

community inclusion.

The New Virginia Waydemonstrates a strong commitment

to saety, quality and protection o

human rights.

The New Virginia Way embracesthe principles o sel-determination,

helping people with ID/DD have

reedom, authority and control over

their own lives.


5/24

Implementation O The New Virginia Way

The Call To aCTion

ProVide addiTional id/dd waiVersTo helP The 7,400 indiViduals/families

who are waiTing for serViCes.

deVeloP a robusT & ComPrehensiVe dd waiVerThaT PromoTesCommuniTy inTegraTion & resulTs in suCCessful TransiTions.

learn from oTher sTaTes who haVe Planned & imPlemenTed suCCessful

TransiTions To CommuniTy sysTems.

suPPorT families from The beginning. ensure infanTs & Toddlers haVe

aCCess To QualiTy early inTerVenTion serViCes wiThouT delay.

suPPorT a renTal subsidy for PeoPle wiTh id/dd who reQuesT inTegraTedresidenTial serViCes.

ProVide suPPorT To indiViduals wiTh id/dd who are foundineligible for waiVer serViCes (due To iCf/mr CriTeria) by allowing ThemTo aCCess The indiVidual & family suPPorT Programs.

dediCaTe reVenue obTained fromTraining CenTer land sale/lease To hewaiTing lisT families.

Transfer id/dd waiVer & iCf budgeT auThoriTy To dbhds,whiCh CurrenTly serVes as The lead agenCy for id/dd serViCes.

ensure ThaT id/dd waiVer raTes are based on The suPPorT needs

of The indiVidual & Take inTo aCCounT regional eConomiC differenCes.


6/24

Thousands Continue To Face Segregation & Isolation

more Than 18,000 VirginianswiTh id/dd are liVing wiTh a family

member oVer The age of 60.State o the States in Developmental Disabilities, 2011

DBHDS Report, Waiting List by CSB, 10/2012

DMAS, 10/2012

more Than 7,500 Virginians wiTh

id/dd are on waiTing lisTs forCommuniTy-based serViCes.>>ID Waiver Waiting List: 6,400

>>DD Waiver Waiting List: 1,142

DBHDS Report, Waiting List by CSB, 10/2012

more Than 3,700 of The indiVidualson The waiTing lisTs haVe been

idenTified as being in urgenT need.

DBHDS Presentation to Senate Finance Committee, 8/2012

949PeoPle wiTh id/dd are liVing in

sTaTe-oPeraTed insTiTuTions.

DBHDS Comprehensive State Plan, 2012 2018

Csb haVe idenTified an

addiTional 935 PeoPle in need ofCommuniTy-based serViCes whoare noT refleCTed on id/dd waiVer

waiTing lisTs.

Virginians wiTh id/dd need your helP

more Than 1,300 PeoPle on Theid/dd waiTing lisTs haVe been

waiTing 5years or more.DBHDS Report, Length o Time on Both

Urgent & Non-Urgent Waitlist, 10/2012

844 Children & adulTs wiTh id/ddare liVing in PriVaTe nursing homes.

DBHDS, 9/2012


7/24

new waiVers (fy13)

2

2

3

9

12

6

20

5

3

3

9

14

2

34

2

10

5

5

12

3

10

4

6

8

127

6

3

2

9

22

7

6

14

2

2

6

175

ALExANDRIA CSB

ALLEGHANy-HIGHLANDS CSB

ARLINGToN CouNTy CSB

BLuE RIDGE BH

CENTRAL VIRGINIA CS

CHESAPEAkE CSB

CHESTERFIELD CSB

CoLoNIAL BH

CRoSSRoADS CSB

CuMBERLAND MouNTAIN CS

DANVILLE-PITTSyLVANIA CS

DICkENSoN CouNTy BHSDISTRICT 19 CSB

EASTERN SHoRE CSB

FAIRFAx-FALLS CHuRCH CSB

GooCHLAND-PoWHATAN CS

HAMPToN-NEWPoRT NEWS CSB

HANoVER CouNTy CSB

HARRISoNBuRG-RoCkINGHAM CSB

HENRICo AREA MH&DS

HIGHLANDS CS

LouDouN CouNTy CSB

MIDDLE PENINSuLA-NoRTHERN NECk CSB

MouNT RoGERS CSB

NEW RIVER VALLEy CS

NoRFoLk CSBNoRTHWESTERN CSB

PIEDMoNT CS

PLANNING DISTRICT oNE BHS

PoRTSMouTH DBHS

PRINCE WILLIAM CouNTy CSB

RAPPAHANNoCk AREA CSB

RAPPAHANNoCk-RAPIDAN CSB

REGIoN TEN CSB

RICHMoND BHA

RoCkBRIDGE AREA CS

SouTHSIDE CSB

VALLEy CSB

VIRGINIA BEACH CSBWESTERN TIDEWATER CSB

Csb urgenT non-urgenT ToTal

19

10

27

107

151

77

281

53

34

36

92

142

6

493

15

131

62

60

140

32

119

47

64

118

16490

63

25

16

111

318

86

65

165

10

12

77

23371

19

9

53

119

38

78

235

47

34

37

51

031

3

337

20

168

43

30

216

47

58

6

74

52

10770

34

17

18

109

58

33

42

151

14

21

34

12539

38

19

80

226

189

155

516

100

68

73

143

173

9

830

35

299

105

90

356

79

177

53

138

170

271160

97

42

34

220

376

119

107

316

24

33

111

358110

ToTal 3,723 2,677 6,400 300

Every Community Is Aected

>>Local DD Waiver waiting list data not available due to DMAS HIPAA restrictions.

Our son, Jimmy, has been on the DD Waiver waiting list for more than five years. We cannot manageJimmys continued care in our home and community without the Waiver services. We shouldnt have tohoose between our livelihoods and our child he belongs with us, not in an institution .

>>Rachel Kirkland, Prince William

DBHDS, 10

The waiTing lisT Crisis

id waiVer waiTing lisT by Csb


8/24

end The waiT: id waiVer

NEW ID WAIVERSPRoVIDED IN Fy

REAL WAITING LISTGRoWTH IN Fy

real growTh of id waiVer waiTing lisT v. new id waiVers funded (fy07 fy12)

1024

600

902

399

782

255

594

0

250

640

745

275

Fy07 Fy08 Fy09 Fy10 Fy11 Fy12

T id wv wt lt h n d sc fy06

w it hpp: n wv hv nt kpt Pc wt gt

WAITING LIST CouNT oN JuNE 30, 2006

6253

57835393

4799

3345

3872

4375

CuMuLATIVE GRoWTH SINCE JuNE 30, 2006

(87%inCr

easesinCefy06)

Fy06 Fy07 Fy08 Fy09 Fy10 Fy11 Fy12

NEW GRoWTH IN CuRRENT FISCAL yEAR

Funding Has Not Kept Pace With Growth

d waiVer waiTing lisT growTh (fy06 fy12)

DBHDS, Wait List History, 1/2012; DBHDS, Waiting List by CSB, 6

DBHDS, Wait List History, 1

(aVerage

growTheQuals780/year)


9/24

furTher aCTion is reQuired

T st: n o n wv mt ec av a g>>A total o 780 ID Waivers are needed each year to prevent urther growth.

>>A total o 1475 ID Waivers are needed each year to eliminate the waiting list by 2021.

>> ID WAIVER WAITING LIST ToTAL AS oF JuNE 30, 2012: 6,253

>> PRoJECTED GRoWTH Fy12 Fy21 (780/yEAR 9 yEARS): 7,020

>> 2012 ID WAIVER WAITING LIST ToTAL + PRoJECTED GRoWTH: 13,273

>> NEW ID WAIVERS IN BuDGET/SETTLEMENT: 2,865

>>WAITING LIST ToTAL IN 2021 IF No FuRTHER ACTIoN IS TAkEN: 10,408

V o Pv T m n o wv rq b

T at, m T 10,000 Pp w b wt i fy21.

2012 2021

10,408

6,253

NuMBERoFPEoPLEoN

ID

WAIVERWAITINGLIST

2012 2015 2018 2021

WITHNoN

EWIDWAIV

ERS

WITHWAIVERS

PRoVIDEDByS

ETTLEMENT

WITH WAIVERS PRoVIDED By SETTLEMENT/BuDGET + 460 ID WAIVERS/yEAR

WITHWAIVERSPRoVIDEDBySETTLEMENT/BuDGET+1155WAIVERS/yEARNuMBERoFPEoPLEoNIDWAIVER

WAITINGLIST

14000

12000

10000

8000

6000

2000

1000

0

(780 ID WAIVERS ToTAL)

(1475IDWAIVERSToTAL)

Waivers Provided By Settlement Will Not Meet The Need


10/24

end The waiT: dd waiVer

T dd wv wt lt h m T d sc fy08

Funding Has Not Kept Pace With Growth

w it hpp: n wv hv nt kpt Pc wt gt

WAITING LIST CouNT oN JuNE 30, 2008

1062

873

696 696

423

CuMuLATIVE GRoWTH SINCE JuNE 30, 2008

(151%inCreasesinCefy08)

NEW GRoWTH IN CuRRENT FISCAL yEAR

dd waiVer waiTing lisT growTh (fy08 fy12)

DMAS, 10

NEW DD WAIVERSPRoVIDED IN Fy

REAL WAITING LISTGRoWTH IN Fy

real growTh of dd waiVer waiTing lisT v. new dd waiVers funded (fy09 fy12)

354

165

Fy09 Fy10 Fy11 Fy12

DMAS, 10

(aVerage

growTheQuals212/year)

Fy08 Fy09 Fy10 Fy11 Fy12

192

15 15 1515

288


11/24

furTher aCTion is reQuired

T st: n o n wv mt ec av a g>>A total o 212 DD Waivers are needed each year to prevent urther growth.

>>A total o 330 DD Waivers are needed each year to eliminate the waiting list by 2021.

>> DD WAIVER WAITING LIST ToTAL AS oF JuNE 30, 2012: 1,062

>> PRoJECTED GRoWTH Fy12 Fy21 (212/yEAR 9 yEARS): 1,908

>> 2012 DD WAIVER WAITING LIST ToTAL + PRoJECTED GRoWTH: 2,970

>> NEW DD WAIVERS IN BuDGET/SETTLEMENT: 380

>>WAITING LIST ToTAL IN 2021 IF No FuRTHER ACTIoN IS TAkEN: 2,590

V o Pv T m n o wv rq b

T at, m T 2,400 Pp w b wt i fy21.

2012 2021

2,590

1,062

NuMBERoFPEoPLEoNDDWAIVERWAITINGLIST

2012 2015 2018 2021

WITHNoN

EWDDWA

IVERS

WITHWAIVERS

PRoVIDEDBy

SETTLEMENT

WITH WAIVERS PRoVIDED By SETTLEMENT/BuDGET + 170 DD WAIVERS/yEAR

WITHWAIVERSPRoVIDEDBySETTLEMENT/BuDGET+288WAIVERS/yEARNuMBERoFPEoPLEoNDDWAIVER

WAITINGLIST

3000

2500

1500

1000

500

0

(212 DD WAIVERS ToTAL)

(330DDWAIVERSToTAL)

Waivers Provided By Settlement Are Not Sufcient To Meet The Need


12/24

imProVe CommuniTy inTegraTion

* Only FY11 data available or Nursing Homes & IC

+ Missing data or 146 people who live in Group Ho

DBHDS, 9/27

34.9% (3,786)GRouP HoME

31.7% (3,437)

WITH FAMILy

7.8% (844*)NuRSING HoMES

3.3% (364*)PRIVATE INTERMEDIATE

CARE FACILITy

.7% (72)oTHER

8.7% (949)TRAINING CENTERS

8.6% (933)SPoNSoRED RESIDENTIAL

4.3% (475)oWN HoME/APT

57% (25+

size of waiVer grouP hom

PeoPle wiTh id/dd reCeiVing day & emPloymenT serViCes

Strategic Plan or Employment First, DBHDS, 10& ID/DD/DS Reports: Recipient and Payment Data DMAS, 8/2012 (FY11 or ID/DD Waivers & FY10 or DS W

f Pp wt id/dd a lv i itt stt

PeoPle reCeiVing id serViCes by The loCaTion of residenCe fy12

Waiver Structure Does Not Incentivize Smaller, Integrated Settings

f Pp wt id/dd a w i itt stt

43% (1,578)< 4

37% (1,350)7+

20% (732)5 6

no daTa aVailable for dd waiVer)

>>

>>

2.8% (194)INDIVIDuAL SuPPoRTED EMPLoyMENT

9.2% (648)GRouP SuPPoRTED EMPLoyMENT

13.2% (925)PREVoCATIoNAL

d waVier (fy11), dd waiVer (fy11) & ds waiVer (fy10)

74.8% (5,241)DAy SuPPoRT PRoGRAM


13/24

PeoPle wiTh disabiliTies,families & ProViders rePorT

ThaT The waiVer reimbursemen

raTes are inadeQuaTe:

>>Our organization can support

individuals with complex medical andbehavioral needs successully in

the community, but the current

reimbursement rate or the provision

o these services is insufcient.

Karen Smith, Executive Director

The Arc o Greater Prince William/

INSIGHT

Provider o ID/DD Waiver Services

>>We have struggled or many years to

fnd qualifed people to care or our

son. The hourly rate o pay under the

Consumer Directed program does not

encourage people to provide these

services.

Sue Vail, Family Member

Roanoke

>>It is very difcult or me to fnd good

support with the pay that is providedthrough the DD Waiver. Without acce

to a qualifed personal care assistant,

I am at risk o institutionalization.

Marisa Laios, Sel-Advocate

Fairax

aVerage sPending Per CaPiTa for

suPPorTed liVing/Personal Care

$21.16

uNITED STATES VIRGINIA

$9.94

State o the States in Developmental Disabilities Project, 2012

MID-ATLANTIC(DE, DC, MD, PA, VA, WV) VIRGINIA

Virginia hCbs* waiVer funding

v. oTher mid-aTlanTiC sTaTesPer CaPiTa)

Home & Community-Based Services

$103

$56

State o the States in Developmental Disabilities, 2011

ProVide QualiTy serViCesWaiver Reimbursement Rates Result In Insufcient Access To Services


14/24

PerCenT disTribuTion of Persons in CommuniTy seTTings by suPPor

nTensiTy sCale leVel of need & liVing arrangemenT* (id waiVer)

LEVEL 4: ++BEHAVIoRAL SuPPoRT NEEDS

LEVEL 2: AVERAGE SuPPoRT NEEDS

LEVEL 1: -AVERAGE SuPPoRT NEEDS

LEVEL 5: +MEDICAL TREATMENT NEEDS

LEVEL 3: +AVERAGE SuPPoRT NEEDS

DBHDS Sustainability Workgroup, 1

GRouPHoME

FAMILyHoME

SuPPoRTEDLIVING/APT

LIVESALoNE

LIVES WITHFAMILy

42%

27%

61%

77%

48%

29%

10%

15%

32%

31%

4%

13%

12%

12%

7%

10% 2%8%

6%

6%

9%

3%

2%

5% 1%3%

5%

11%

2%

9%

indiVidualize suPPorTsWaiver Reimbursement Is Not Based On Level O Support Provided

suPPorTs inTensiTy sCale: (LEVEL 1 LoWEST >> LEVEL 6 HIGHEST)

LEVEL 6: ++ BEHAVIoRAL CoNTRoL NEEDS

MORE PEOPLE WITH ID/DD COULD BE LIVING IN INTEGRATED SETTINGS

Professionals in the field are prone to chronically underestimating people with disabilities, and not just their skills but their dreams,mbitions and hopes as well. This is especially true for people with complex support needs who rarely are considered to want and be ableo li ve in th ei r own home an d no t a co ng re ga te faci li ty . Th is is abso lu te no ns en se . Anyone can live and be supported in their own

home, it starts with believing and then having the right supports in place the former being the biggest hurdle.>>Lynne Seagle, Executive Director, Hope House Foundation


15/24

aVerage CosT of residenTial serViCe oPTions

TRAINING CENTER

CoMMuNITyINTERMEDIATECARE FACILITy

INDIVIDuALS WHo MoVEDFRoM TRAINING CENTER

uSING WAIVER

ID WAIVER SERVICES(CoNGREGATE &

NoN-CoNGREGATE)

ID WAIVER RECIPIENNoT uSING CoNGREGRESIDENTIAL SERVIC

$224,245

$46,266

$75,465

$138,000

$104,000

righT now:>>Provide the up-ront adjustments in ID/DD Waiver reimbursement rates that were

recommended in the BBBBB study in order to ensure saety and quality in community

services while the Waiver re-design takes place.

aCTions needed To PromoTe inClusion Through id/dd waiVer serViCe

when redesigning The waiVer:>>Calculate the true cost o providing services (i.e. sta training, overnight support, etc.) and

then adjust reimbursement rates accordingly.

>>Ensure that reimbursement rates are based on meeting the needs o each individual andtake into account regional economic dierences.

>>Adjust reimbursement rates and Waiver structure to incentivize community integration.

>>Utilize individual budgets and promote the principles o sel-determination in ID/DD

Waiver Programs.

>>Provide an annual cost o living adjustment to ensure reimbursement keeps pace with the

cost o providing services and prevent the Commonwealth rom alling behind in quality.

inVesT in inClusionThe Most Integrated Services Are Also The Most Cost-Eective


16/24

imProVe our fisCal efforTThe Bottom Line: Virginias System Is Underunded

uNITED STATES

VIRGINIA

Virginias fisCal efforT v. naTional aVerage (fy77 fy09)

State o the States in Developmental Disabilities,

Fy77 Fy84 Fy87 Fy84 Fy97 Fy02 Fy03 Fy06 Fy09

State o the States in Developmental Disabilities Project,

Virginia is ranked 45Th

for our fisCal efforT Toward id/dd serViC

NEW yoRk

2 MAINE

3 CoNNECTICuT

4 MINNESoTA

5 NoRTH DAkoTA

6 LouISIANA

7 oHIo

8 IoWA

9 RHoDE ISLAND

0 VERMoNT

$ 10.10

$ 8.32

$ 7.69

$ 7.54

$ 7.28

$ 7.13

$ 6.84

$ 6.50

$ 6.31

$ 6.21

42 uTAH

43 MARyLAND

44 kENTuCky

45 VIRGINIA

46 ALABAMA

47 CoLoRADo

48 GEoRGIA

49 FLoRIDA

50 TExAS

51 NEVADA

$ 2.9

$ 2.8

$ 2.8

$ 2.7

$ 2.2

$ 2.2

$ 2.1

$ 2.0

$ 1.9

$ 1.5

ToP Ten sTaTes boTTom Ten sTaTes

$2.24

$1.97

$1.89

$2.57

$2.09

$3.50

$4.02

$4.25$4.34

$2.41

$2.53$2.73

Fiscal Eort is total spending or ID/DD services per $1,000 statewide personal income)


17/24

The Framework Helps Virginia Move To A Community System

addiTional waiVers>>Virginia will provide 4,170 additional ID/DD Waivers betweenJuly 1, 2011 and June 30, 2021 to help people with ID/DD transition rom institutions, includinTraining Centers, and avoid unnecessary institutionalization.

Plan To Close insTiTuTions>>Virginia will provide a plan to the General Assembly cease residential operations at our o Virginias training centers by 2021.

family suPPorTs>>Virginia will develop an Individual and Family Support Program or1,000 individuals on waiting lists to help provide care in their amily or own home, and prevent

unnecessary institutionalization.

Crisis sysTem>>Virginia will develop astatewide crisis system or individuals with ID/Dand their amilies. The crisis system shall provide services ocused on prevention and planning

to avoid crisis, as well as in-home community-based crisis services that are directed at resolving

crisis and preventing removal o an individual rom current placement. The crisis system

shall include a 24/7 hotline, regional mobile crisis teams and regional community-based crisis

stabilization programs.

Case managemenT>>The Commonwealth will provide enhanced case management orindividuals with more complex needs, who have experienced crises, are in congregate settings,

are receiving services rom providers with conditional licenses.

inTegraTed emPloymenT>>Virginia will implement an Employment First policy,prioritizing integrated, competitive-wage supported employment, and expand integrated

employment and integrated day activity opportunities.

oVersighT of safeTy & QualiTy>>Virginia will establish a quality and riskmanagement system with qualitative and quantitative measures, with sustained ollow-up or

transitioned individuals.

The us v. Virginia seTTlemenT agreemenT

indiVidualized disCharge Planning>>The Commonwealth will develop sae,individualized discharge plans or all individuals in Training Centers using a person-centered astrengths based process. The Commonwealth will ensure that essential supports are in place pr

to the individuals discharge rom the Training Center.

inTegraTed residenTial>>The Commonwealth shall acilitate individuals receivingHCBS Waivers under this agreement to live in their own home, leased apartment or amilys

home, when such a placement is appropriate to their needs. The Commonwealth will be required

to develop a plan to increase access to independent living options such as individuals own hom

or apartments. Virginia must also provide a one-time und o $800,000 to provide and administe

rental assistance.


18/24

VA

IO

AR

DE

NC

MO

MS

NVUT

WY

ID

NE

Virginia Is One O Few States That Has Not Closed An Institution

>>Only 12 states have not closed a single institution.

151 ComPleTed & in-Progress insTiTuTional Closures in 39 sTaTes

State o the States in Developmental Disabilities, 2012

14 sTaTes haVe zero

sTaTe-oPeraTed insTiTuTions

DISTRICT oF CoLuMBIA, NEW HAMPSHIRE

VERMoNT

RHoDE ISLAND

ALASkA, NEW MExICoWEST VIRGINIA

HAWAII, MAINE

MINNESoTA

NDIANA

oREGoN

MICHIGAN

ALABAMA

1991

1993

1994

19971998

1999

2000

2007

2009

2010

2011State o the States in Developmental Disabilities,

10 sTaTes haVe a sTaTe-oPeraTed

insTiTuTion Census of 170 or le

NEVADA

IDAHo

MoNTANA

DELAWARE

WyoMING

NoRTH DAkoTA

ARIzoNA

SouTH DAkoTA

CoLoRADo

MARyLAND

naTional shifT To CommuniTy-based serViCes

State o the States in Developmental Disabilities,


19/24

Close The fronT door.>>

Take action to eliminate risk o institutionalizatby reducing ID/DD Waiver waiting lists and

increasing reimbursement rates, ensuring that

Virginians with ID/DD, regardless o complexity

support needs, can live saely and successully i

the community.

Virginias TransiTion To a CommuniTy sysTem

do iT for The righT reasons.>>Make a commitment to supporting all people

with ID/DD in the community because it is the

right thing to do, not because it is cheaper.

Keep costs savings (including sale/lease o landin the system and use them to acilitate success

transitions and strengthen Virginias

community-based system.

uTilize besT-PraCTiCes & ProVensTraTegies.>>Implement proven strategies or successul

transition (i.e. individual budgeting, person-

centered planning and amily/peer mentoring.)

>>Invest in intensive oversight, outcome/quality

measures and aggressive post-move monitoring.

Think ahead: ensure ThaT legislaTion

& budgeT aCTions refleCT The new

Virginia way.>>Enact policy that promotes integrated residenti

services, competitive employment and true

community inclusion or people who transition

rom institutions to community.

CommiT To budgeT TransParenCy.>> Require regular reports on both ID/DD Waiver

spending and cost-savings (including capital co

avoidance). Ensure that these detailed reports a

made public.

make Virginia a leader in id/dd serViCe>>Take advantage o the unique opportunity to lea

rom other states who have been down this path

Build on these eorts and strive to develop

additional best-practices that urther promote

sel-determination and community inclusion.

Building A Foundation To Ensure Success


20/24

CommuniTy for all

It is well-documented that individuals who leave institutions and move into the community hav

abetter quality o lie, improve adaptive behaviors and acquire more skills that help them o

a daily basis. Transition to a community home makes a signifcant impact on acquisition o the mo

complex cognitive and social skills. While transitions can be challenging, the long term impa

o moving rom institutions to community is almost universally positive or all ages and

disability levels.

>>Brie Amici Curiae on Behal o NASDDS, AAIDD, AUCD, TASH & Robert Gettings, 4/5/2012

>>The Pennhurst longitudinal study ollowed more than 1,100 individuals over a 5-year period.

In that study, it was ound that people became more independent and showed improvemen

in adaptive behavior.

>>In a review o 19 studies o 1358 subjects, rom 13 states, Sheryl Larson and Charlie Lakin

concluded that institutions were consistently less eective than community-based

settings in promoting growth,particularly among individuals who experienced signifcantintellectual disability.

>>In a later review o 33 research evaluations, Kim, Larson and Lakin ound that the literature

continued to support improvements in adaptive behaviors that are consistently ound in

individuals who are transitioned to the community (and that moving to the community als

diminishes challenging behavior).

Virginias Transition To Community Is Not Unprecedented

sTudies haVe shown ThaT eVeryone Can benefiT from CommuniTy liVing.

PeoPle who benefiT The mosT are Those labeled wiTh The mosT seVere disabiliTies


21/24

Numerous studies have been done on this issue.

A summary o those studies by Lynda Anderson

and Sheryl Larson at the University o

Minnesota ound:

>>The vast majority o parents changed their

attitude about transition and reported postive

opinions ater their amily member moved to

the community.

>>Parents also observed improved quality o lie

and relationships or their amily member

ater the move.

>>Ater experiencing community services,

parents viewed the institution less positively

than they did when their amily member

lived there.

whaT researCh & exPerienCe Tell usMoving To A Community System Is Good Public Policy

rc s Tt f m attt C dtc at Ct

Pct. ev w f it opp T T, T gt mjt utt

bc sppt o Ct Pct.

Family Perceptions: Beore & Ater Transit

>>BEFORE community placement, less than

20% o amilies agreed with transition to th

community and 58% strongly opposed it.

>>AFTER community placement, 66% o

amilies strongly agreed with transition

to the community and less than 5%

opposed it. "Shattering Myths," The Arc o Mar

Positive Feelings Also Grow Stronger

Over Time

>>Families positive attitudes about communi

living grow stronger the longer relatives a

out o institutions. Family members are ot

surprised by their own change in eelings

and report unexpected changes or the bett

in their own lives, and in the lives o their

disabled relatives. Penn


22/24

Newspaper Editorials From Major Media Markets

Were glad to see McDonnell agreed to settle with DOJ. Virginia or too long has been

behind in properly caring or all our residents. The expansion o strong, community-

based care and additional Medicaid waivers so amilies can keep their loved ones at

home is the right thing to do or the residents and a prudent move or our budget.

>>1/29/2012

Closing insTiTuTions is a welCome sTeP

The News Leader

The roaNoke Times

Virginia and its loose system o community services boards have to build a structure

or community care that is sae and nurturing. It cant happen i the state continues to

operate expensive institutions. Change is past due.

>>4/3/2012

The righT Care

Virginia should never again lock away its most vulnerable sons and daughters with

the shameul words, Nothing else is available at this time.

>>2/18/2011

Care for disabled is Virginias shame

The virgiNiaN-piLoT

The past cannot be justifcation or accepting the status quo as the best the

Commonwealth is capable o providing or the most ragile Virginians. Rather it must be

the motivating orce or embracing reorm with vigor while good intentions are resh.

>>8/29/2012

beTTer Care for more PeoPle

The roaNoke Times

Call for reform


23/24

Virginians Support A Community-Based System

In transorming their service systems or persons with ID/DD, these States have maximize

unding, minimized per person costs, and vastly expanded the number o individuals serve

The agreement provides the oundation or Virginia to do the same.

>>Brie Amici Curiae on behal o NASDDS, AAIDD, AUCD, TASH & Robert Gettings, 4/5/20

suPPorT for The TransiTion

Judge gibney, The federal Judge Presiding oVer us v. Virginia, reCeiVed more

Than 800 leTTers of suPPorT from PeoPle wiTh id/dd, family members,Professionals and ConCerned CiTizens.

a CoaliTion of 70 Virginia sTakeholder organizaTions, rePresenTed byThe bazelon CenTer for menTal healTh law, submiTTed a sTaTemenT in suPPorT of

The agreemenT To The CourT.

hundreds of PeoPle aTTended The June 8, 2012 fairness hearing in suPPorof The agreemenT.

seVeral rePuTable sTaTe and naTional organizaTions, rePresenTedby The CenTer for PubliC rePresenTaTion, submiTTed amiCi briefs in suPPorT of

The agreemenT.


24/24

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