The Arc of Illinois

January 13, 2009

Leaders in The Arc:

Yesterday I took the sunrise jet to Washington D. C. to meet our new Executive Director of The Arc of the United States, Peter Berns. The purpose of the meeting was to get to know each other and discuss the Illinois Proposal on Governance & Local Chapter Fees. We had a very good discussion and now the Arc U.S. Board of Directors is going to review this proposal.

Peter is a sharp Exec with excellent experience in nonprofit association work. He understands value in membership and important positive relationships with members. He was the Exec of a statewide association of nonprofits in Maryland before this position. He is now learning the important work of The Arc. I look forward to a long working relationship with Peter.

In Springfield, the Commission on Governmental Forecasting & Accountability (CGFA) postponed its vote on recommending or not recommending the closing of Howe. This gives advocates more time to contact their legislators asking them to support the closing of Howe. See below an Illinois Council on Developmental Disabilities summary of the continuing problems at Howe. Recently, two more individuals have died at Howe. Very sad.

Tony Paulauski

The Arc of Illinois

815-464-1832

Support the Closure of Howe Developmental Center -

2 More Deaths at Howe Since the CGFA Hearing on December 11, 2008

Despite intensive efforts and the diversion of millions of dollars of limited state funding, there has been little decrease in the frequency and intensity of these significant incidents.  These types of incidents led to decertification, and have continued to hamper efforts to regain certification.  Howe was de-certified nearly 2 years ago and despite intensive efforts has not been able to regain certification.

Compelling Reasons to Support the Closure

1.       Deaths and Significant Incidents at Howe

Deaths and Mortality Rates -- Since the CGFA hearing on December 11, 2008, two more people have died.  The death occurring on December 29^th is currently being investigated by the Office of the Inspector General (OIG).

 Since July 1, 2007, 35% of all deaths in SODCs have occurred at Howe Developmental Center.  That's over 27 deaths since 2004.  Of the 16 deaths since July 2007, eight had autopsies completed.  Guardians of the remaining 8 declined a request for an autopsy.  It is important to note, that there maybe underlying causes to these deaths, as discovered in previous reports from EFE.

When looking at data for mortality rates, it is clear that the Howe Developmental Center consistently demonstrates the highest mortality rate across the SODC system. 

Over the five-year period, among Centers of like size (i.e., serving 300 to 400 people), Howe's figures nearly double that of Murray and Ludeman.  In fact, Howe's number of deaths is comparable to that of Shapiro, which serves approximately 200 more people.

Significant Incidents -- There continues to be a high level of significant incidents that hinder certification efforts.  These incidents have included, but are not limited to:

·         a wheelchair-bound  person acquiring a fractured ankle;

·         people who are assigned twenty-four hour staff supervision (known as, one to one supervision, where staff are to be within an arm's length of the person at all times) being found unsupervised;

·         people with assigned one to one supervision being injured, due to self injurious behavior, falling, having pica (eating/ingesting inedible objects) incidents, or the cause of the injury being documented as unknown;

·         errors in medication administration;

·         failure to follow physician orders;

·         failure to properly initiate emergency response procedures, e.g. CPR;

·         failure to appropriately implement individualized support programs which are individually designed to protect clients; and

·         lack of thoroughness in clinical documentation.

It is important to recognize that Howe has a disproportionate share of significant incidents when compared to other SODCs.  Yet, it has the highest staff-patient ratios of all the SODCs.

 These incidents and the ones listed on Attachment C are significant especially in view of the heightened level of oversight at the facility. 

·         3 incidents listed were observed by management staff (1/29/08,6/17/08/ 9/2/08).  2 of these are still under review.  One of these (6/17/08) resulted in staff being arrested and charged but charges were dismissed as witnessing staff did not support the account given by management staff.  One can responsibly conclude that there is a culture of staff covering for staff.

·         Living environment - on 7/11/08, 7/31/08, 8/16/08, and 12/12/08 drug sniffing dogs had to search two homes at Howe because staff had accused one another of stealing drugs; on 2 occasions residents of a home had to move to another to ensure staff-patient rations because staff had called in not reporting to work, and on another occasion last month, 20% of the staff in for a union holiday party resulting in 206 overtime hours for other employees in a single shift.

·         With this level of significant incidents with enhanced oversight, one can only wonder the depth and breadth without this oversight.

·         You will note that the terms substantiated, unsubstantiated and unfounded in the list of incidents.  Unsubstantiated means that the event may have occurred but for various reasons could not be documented at a 'substantiated' level. 

2.       Economics and the Illinois' Fiscal Crisis  

Federal funds -- Loss of federal funds for the facility and for other facilities since funds are being diverted from DDD's budget and the budgets of other SODCs to maintain the facility.

General Revenue Funds - GRF costs to the State to date is $44 million in lost federal matching funds, and continues to cost the State $2.2 million each month it remains open and decertified.

Another $7 million has been spent by the State on certification efforts by State staff, other SODC staff, including facility directors, nationally recognized experts in re-certification efforts.. all of which is coming from other SODC budgets and the budgets for community-based providers.  This is on top of Howe's $55 million annual appropriation for substandard care.  The level of resources being diverted from other SODCs and the community are not being used effectively. 

The reallocation of funding to Howe has caused other SODCs to lose federal matching funds and limiting their ability to hire staff, purchase equipment, etc.

The economic impact report completed pursuant to the CGFA's statute entitled "Impact of the Closures of the Howe and Tinley Park Facilities" performed by the Regional Economics Applications Laboratory, Institute of Government and Public Affairs, University of Illinois, November 2008 indicates ".suggests that the impacts on the community of Tinley Park from the closure of these facilities is likely to be relatively modest."  It goes further to state ".. From an economic impact perspective, the impacts are modest; if both facilities were closed and all employees left the region completely, the total impact would amount to less than 0.03% of the Chicago regions employment."  As everyone knows, the majority of the workforce at Howe will be transferring to other SODCs in the Chicago region.    

Summary:  Howe Developmental Center was decertified in 2007 by federal surveyors based on repeated surveys by the U.S. Department of Health and Human Services, Centers for Medicare and Medicaid and the State.  The U.S. Department of Justice has investigated Howe twice.  Their most recent on-site investigation at Howe concluded with negative feedback in virtually every area of operation and an expression of grave concern regarding the ability of the Center to keep people free from harm was made by every attorney and every expert on the team.

Second, and significantly, this is the second time DOJ has investigated Howe.  DOJ's first investigation of Howe in the 1980s concluded with the Department entering into a consent decree; by the time DOJ returned to Howe in 2007, they voiced many concerns regarding the services they observed.

In every case, the reviews done by these entities have demonstrated concern with the quality of care and the potential risk of harm to those who live at the Center. 

 After considerable outlays of staff and fiscal resources, the use of nationally recognized consultants, and the significant expertise of facility directors at other Illinois state-operated facilities, the Center remains decertified.  Based on these factors, quality of care issues, abuse and neglect and deaths of residents, and the fact that other facilities are being put at-risk because of the resources allocated to Howe, we strongly encourage you to support  closure of  the facility. 

This closure process cannot be delayed any longer.