Wednesday, February 18, 2009

Problems at the Family Care Homes in NC where low income people w/ mental health concerns live: how common are they?

This is the second of two letters I have now sent to Buncombe DSS Adult Protective Services, regarding a Family Care Home in Buncombe County, western NC. I have asked DSS Buncombe to make clear clients' rights pertaining to mental health services that take place as associated w/ residents who live in Family Care Homes in NC.

If you want to know where some of the homeless people are, clearly, if they have Medicare or Medicaid services, many of them are living in Family Care Homes where they are provided a place to sleep and keep their things, food on the table, transportation to medical appointments (some of the time).

While these homes do prevent people from being homeless, the down-side is that the residents' disability checks are almost always controlled by the businesses that run the homes. This means that residents have little to no spending money and essentially become wards of the homes-----rather than wards of the psychiatric hospitals.

A better alternative, which is written into a carefully thought out law governing Family Care Homes, is to allow---as is possible---the residents to manage their own money and pay for their room and board. This would take the management of the residents' money out of the control of the Family Care Homes. Indeed, the law supports residents managing their own money but this is seldom done.

There are two streams of funding that pay for their room and board: 1. their disability checks which are of varying amounts (see below) and 2. the balance if made up by the county DSS. It costs approximately $1275/ month for the room and board at these homes. As I understand it, this is a uniform amount across all of NC.

I did receive a reply back from Courtney Landis of Western Highlands Network, the LME in Buncombe county, re: matter of a resident being able to obtain their own financial information in order to obtain certain services, such as a discounted YMCA membership. Ms. Landis stated to the Family Care Home which is alluded to below----a matter which assumably would include all Family Care Homes----that it is not unusual for residents to have to evidence their own financial information for such purposes as IPRS (state funding) mental health services. Thus, it appears that Western Highlands Network has come down on the side of residents having the right to make evident their financial information.

This being said, as has been the case re: this family care home, they can still continue to drag their feet re: the necessary paperwork, thus blocking necessary and requested services----requests that were made by the clients.

Eventually it comes down to how many hours in a day are there to be spent trying to get an answer and an appropriate response to a reasonable question. How many chains of command does a provider or resident have to climb in order to make something happen----the something being the release of the client's own paperwork in order that services be obtained?

It would be nice if the public agencies such as the LME and the Department of Social Services would come down more firmly on the side of the client.

What I am trying to suggest is this: the enforcement of the law appears to be neglected.

Marsha V. Hammond, PhD

*****************

Marsha V. Hammond, PhD: Licensed Psychologist: NC
fax: 828 254 2013
cell phone: 404 964 5338
e mail: hammondmv@netzero.com (please utilize WORD 'save as' security options when passing confidential information; send your passwords in a separate e mail)

February 18, 2009

HI Ms. (Sara) Tarpey of Buncombe DSS:

I assume that you, Cheryl Simcox, and Rebecca Sizemore, all associated w/ Adult Protective Services, and speficially attending to matters associated w/ Family Care Homes, received the letter I sent to you last week pertaining to a telephone conversation I had w/ one of -------Homes administrators, J of =========Homes, regarding several issues of concern for him.

I am guessing as to Ms. Simcox's and Ms. Sizemore's e mail addresses. Please forward this letter to them if I have miscalculated.

I am forwarding the letter (see below) also to Western Highlands Network (specifically Courtney Landis: land0803@westernhighlands.org) ---which you were sent the first week of February, 2009, as ---------- Homes has filed a complaint w/ WHN re: me seeing clients at hours of my availability and of their choosing which is commonly early Sunday evenings, specifically, 5:30 pm until 8 pm. This is a quiet time to meet w/ residents and has diminished activity as associated w/ medical, etc., appointments which have taken place during the week.

-------Homes administration has also suggested that I somehow strong-arm clients into working w/ me and/ or (Endorsed Provider company). Nothing could be further from the truth and the signed (by the resident) Consent to Treatment attests to this. This is in the charts of clients who currently work w/ me.

Additionally, I am being blocked----as the clinical psychologist----from obtaining medication information which is in the charts of the residents at ------ Homes. This cannot continue as I interface w/ the medical providers regarding medication issues which are commonly not addressed by ------ Homes.

This all began, you might remember, as associated w/ my desire to simply have the financial information (the amount of the disability check) for resident whose initials are BK, living in ------- Home # 13, so that he could get a discounted YMCA membership. The YMCA cannot give that to him w/o the financial information. However, though I have asked 3 x since November, 2008, -------Homes will not give me the disability check information. ------- Homes also blocked me from taking the client to the SSA in order to get the information. Three months down the road, resident BK still has no YMCA membership because of the lack of financial information.

My suspicion is that -------Homes wants to run me off pertaining to me asking very pointed questions----in letters which were created as I sat w/ concerned residents----- about the monies that are received or not received by the clients/residents as pertaining to the varying amounts of their disability checks and the associated money 'left over.'---which is their monthly spending money.

Their monthly spending money is my concern, I maintain, as with no money to spend, they are left unable to participate in CSS and they become wards of ------ Homes, unable to do anything or purchase anything. I maintain that this is related to their mental health.

Moreover, my questions about their spending money is wrapped around therapy sessions and I seek to present a role model of assertive behavior as regards residents' mental health and welfare.

Additionally, Community Support Services has as a central tenet increasing the independence and responsible functioning of clients/ residents.

In keeping with the tenets of NC mental health reform, I communicate these issue w/ the Endorsed Provider company, ---------. I am demanded by NC mental health reform to be aligned w/ a company as associated with enhanced services. Community Support Services is an enhanced service.

As you are aware, the residents' disability check is one of the two funding streams paying for their room and board at ------ Homes (or any other family home); the other is DSS funding. Residents have varying disability check amounts as regarding the basis for their disability. Some have disability checks based on a parents' social security account. Some have simply Medicaid and SSI. Others have SSDI and a bigger disability check that those who receive simply SSI. However, the amount of money received by residents, issued by ------ Homes, varies tremendously from client to client and unfortunately, it appears that if no questions are asked by the residents about their funds, then the monies simply are swallowed by ----- Homes. This is against the law.

Here is the entire law of which I am aware currently. I have given copies of this to residents so that they can know their rights.

http://ncrules.state.nc.us/ncac/title%2010a%20-%20health%20and%20human%20services/chapter% 2013%20-%20nc%20medical%20care%20commission/subchapter%20g/subchapter%20g%20rules.html

The law states: (chapter 13G-Licensing of Family Care Homes: 10A NCAC 13G.1101 Management of Residents Funds):

"Residents shall manage their own funds if possible."

and

(10A NCAC 13G .1103)
"Accounting for resident's personal funds: (d) A resident's personal funds shall not be commingled with facility funds. The facility shall not commingle the personal funds of residents in an interest-bearing account."

http://ncrules.state.nc.us/ncac/title%2010a%20-%20health%20and%20human%20services/chapter% 2013%20-%20nc%20medical%20care%20commission/subchapter%20g/10a%20ncac%2013g%20.1103.pdf. .

The difficulty w/ ------- Homes cooperating w/ some of the residents' choice of mental health providers in terms of enhanced services (meaning, Community Support Services), is not isolated to me as evidenced by difficulty encountered by L---------, a Community Support Services worker for (Endorsed Provider company).

This being said, I want my encounters with -------Homes vis a vis residents to be completely separate from what is experienced and overviewed by (Endorsed Provider company) in that as re: Medicare and Medicaid clients,I am a completely autonomous professional. All the residents of -------- Homes are Medicare or Medicaid clients.

However, I did want to pass that along to you and ------- can give you more information. Contact person for that is: A----------- . Also cc'd here is L--------- who works w/ Direct Care LLC as well as T--------------- who works w/ -------------as a CSS worker.

I want to make it very clear that I receive no monetary compensation at all from -------- for the task I do for them, specifically, testifying to the medical necessity as pertaining to enhanced services for residents of ------ Homes who choose to work w/ myself and (Endorsed Provider company). We do share clients that are referred to each other. All professionals have referral networks with whom they participate.

The clients are always informed of their ability to make a choice re: their mental health care. The Consent for Treatment forms that are in their charts at ------- Homes, indicates this also.

These are the two items about which I am hopeful that DSS Buncombe can comment, given that you seem to have been assigned (via statute, I suspect as it is not specified in the law governing family homes) the job of overseeing Family Homes. I posed these questions in the letter that I sent you last week via US Post. .

Item 1: "I am asking DSS Buncombe to state whether this matter is applicable to licensed psychologists as the law indicates 'case managers.' This is the specific question DSS Buncombe: is the administration of a family care home to 'cooperate' with a provider who is a psychologist?"

Item 2: "I am asking DSS Buncombe to make a judgment about whether a psychologist who has a written agreement with clients----with the permission of the client----has a right to look at the charts of the residents and to peruse information that is associated w/ the mental functioning of the client."

When can I expect an answer to the two questions?

Here again is the letter I sent to you in the US Mail.

By the way, as regards Item 1 below, I have no fax from the administration of ------ Homes as re: my request for their policy and procedures re: hours of contact w/ clients who reside in their homes. Therefore, as before, I will continue to see clients as associated w/ my availability which is, I believe, reasonable.

----------, administrator w/ ------- Homes, did call me back after receiving my letter. He left a message degrading my professional skills. I will not speak to him on the phone, which I advised him in the letter.

I am looking forward to your response.

I have also routed this to Western Highlands Network, specifically Donald Reuss and as stated above, Courtney Landis. Additionally, the two Community Support Services workers, ----------, as well as their supervisor, -------------- MA, QP, are cc'd.

I have also placed it on my blog, taking out salient names. The purpose of my blog is to inform re: mental health issues in NC. As per other professionals with whom I have spoken, specifically, Tom Smith, MD, psychiatrist, Asheville, NC----there is much to be concerned about as re: these family homes.

Please feel free to forward this information to any pertinent person or entity.

Thanks for your hard work.

Marsha V. Hammond, PhD
*************************************:
Marsha V. Hammond, PhD: Clinical Licensed Psychologist, NC
E mail: hammondmv@netzero.com
Fax: 828 254 2013
Cell phone: 404 964 5338

February 12, 2009

RE: our phone conversation

Dear J --------------- of --------Homes:

I am outlining what we talked about today on our phone call so that we can both be clear and be in accord as pertaining to what we decided.

1. You stated that you wanted providers to be finished w/ seeing clients at ----- Homes facilities by 6 pm. I asked you to fax to me at 828 254 2013 your policy from your policy and procedures manual. For, no client has ever advised me that they do not want to see me. If they do not want to see me (and I have typically come in the early evening on Sundays as this is a quiet time and they have not had their evening meds which commonly make them sleepy), they have advised me and I have always attended to that. When I have received your fax, J-----, from your policy and procedures manual, I agree to not be working with clients after 6 pm. NC state law, specifically, Subchapter 13G, licensing of Family Care Homes, indicates : (10A NCAC 13G .0908): "The administrator shall cooperate with and assure the cooperation of facility staff with case managers in their provision of case management services to the appropriate residents." I agree to not see clients after 6 pm but I wish to have a statement from DSS Buncombe on this matter of cooperation. I am asking DSS Buncombe to state whether this matter is applicable to licensed psychologists as the law indicates 'case managers.' This is the specific question DSS Buncombe: is the administration of a family care home to 'cooperate' with a provider who is a psychologist?

2. You stated that the e mail letter from Donald Reuss, Provider Relations at Western Highlands Network LME, associated with what you term 'conflict of interest' as pertaining to -------- my husband, referring to me clients for assessment and therapy----which is in my jurisdiction as a licensed clinical psychologist in NC---- was not satisfactory as 'anyone could write that.' ------------------ has relayed your dissatisfaction with the e mail venue to Donald Reuss and you can take this up w/ --------------and/ or Donald Reuss, donaldr@westernhighlands.org) at your convenience. During our telephone call, I advised you that the clients are informed about their having choice of providers and I advised you that as per the clients that I see there would be given to the SIC of the various homes a document testifying to this. I will also keep this in my files and ------(Endorsed Provider company) will be forwarded the document also.

3. You stated, J----, that you believe that my looking in the residents' charts while the residents are with me and requesting the information, is not acceptable to you. It is very important for me, as the psychologist, who does the assessments and provides therapy if the client desires this, to look at their charts. First of all, I need to know the medications which are administered to the client. This impacts their physical and mental health and both these domains are in my area of expertise as a psychologist. Moreover, I write letters to physicians re: medications which need to be, perhaps, changed. I call physicians re: these matters. However, your concern re: me looking in the residents' charts seems to be associated with me looking at their personal finances ---while I sit w/ the client who is voicing questions about having no spending money-----which is to say, the information associated w/ co-pays that is extracted from the monies which they are due after their check is utilized to pay for their living expenses to live in the ------- Homes. I advised you on our phone call that having no spending money was impacting the mental and emotional well being of my clients. Moreover, as I have learned more about matter, I believe that some clients----who receive larger disability checks-----merit more money in their pocket than others who receive smaller checks. After talking with Sara Tarpey for 15 minutes the first week of February, and as associated with my concern about these matters, and as re: your concern, J------, that clients do not have the right to allow a mental health care provider to peruse their charts at the homes for important information which affects their physical, mental, and emotional well being, I am asking DSS Buncombe to make a judgment about whether a psychologist who has a written agreement with clients----with the permission of the client----has a right to look at the charts of the residents and to peruse information that is associated w/ the mental functioning of the client.

4. You advised, me, J-------, that you had not received my two phone calls which I made to your cell phone this past month, the phone on which you called me today. I advised you that I would send you letters as we appear not to be able to communicate via phone. You stated 'don't send me letters.' However, you indicated you did receive a letter on the matter of a client w/ the initials BRC pertaining to his funds. Therefore, I assume you receive letters. It is my intention to communicate with you only utilizing the US Post. I consider this to be associated with the matter of 'cooperation' which I hope we can foster.

I hope we can work cooperatively, ------- Homes.

Sincerely,
Marsha V. Hammond, PhD
Cc: Group home/ personal care home manager: Cheryl Simcox: 8282505870
Worker Sara T DSS: 2505660;cell 775 1538
Her supervisor: Roxanne Sizemore 828 250 5721
Sara Tarpey, investigates complaints at family homes: 250 5660, office

2 Comments:

Blogger Gail said...

I run a family care home. You are correct that they are allowed only a certain amount of money back. What you have failed to include in that is that the state says the home must have staff available 24 hours a day. By the time, you pay staff, relief staff,buy food for 6 people,(18 meals a day) pay taxes on the homes, provide transportation to medical appointments, any home is lucky to have maybe a $1000 clear at the end of the month. Sure, if they could be in the homes unsupervised, buy their own food, do their own cooking, monitor their own meds which most cannot do,then you are correct that the resident could have more money in their pocket. Unfortunately, that is not allowed. The state has cut back on the funding as you have stated. I agree with you that less than $40 a month is nothing especially for cigarette smokers, soda and coffee drinkers.
As far as my home is concerned, the residents mail is given to them unopened and if there is a need for staff to interrupt, then it is read and stated in terms they can understand. As far as concerning continuity of care with all providers, I understand that as long as the resident has signed a release of information, then the information is to be given freely. Also, it is the responsibility of the home to make arrangements for transportation for all medical appointments including therapy when deemed medically necessary.

10:35 AM  
Blogger Thomas Taylor said...

Thank you for this post - your article is really sensitive towards the subject of quality care for people with mental health needs. This care home can provide information about what help they can provide.
Nursing homes Kent

2:13 AM  

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