Wednesday, May 13, 2009

NC Family Care Homes: mental health issues go unaddressed & providers are banned from premises: defacto mini-prisons

Marsha V. Hammond, PhD: Clinical / Health Licensed Psychologist, NC e mail: cell: 404 964 5338 fax: 828 --------

May 13, 2009

Dear Doug Barrick, of Department of Health Service Regulations (regulating agency) within NC DHHS:

Thank you for reading this e mail letter. I appreciate your time.

I understand, as per Ms. Lou Morton, in the complaint department at the Department of Health Service Regulation (DHSR),the state agency which oversees Long Term Care (LTC) and more specific to what I am talking about, Family Care Homes, that you are the administrative liason between the NC state legislature & DHSR. If I am mistaken, please forward this e mail to the appropriate person or parties. Indeed, forward it to anyone you like.

I have seen clients at the WNC Family Care Homes for about a year and a half. Over that period of time, management has changed. When these homes morphed from Evergreen to WNC Homes in August, 2008, is when problems began re: working w/; that administration and specifically, Jeff Clifton, of that administration.

Specifically, all hell broke lose as clients complained to me about they not receiving their Personal Needs Allowance (PDA), a record which is demanded to be kept 'in the home' as per this law, within the Family Care Homes law:

"10A NCAC 13G .1103 ACCOUNTING FOR resident's PERSONAL FUNDS(a) To document a resident's receipt of the State-County Special Assistance personal needs allowance after payment of the cost of care, a statement shall be signed by the resident or marked by the resident with two witnesses' signatures. The statement shall be maintained in the home."

Since I like to solve problems rather than endlessly talk about them in therapy, the client and I, with the permission of the Supervisor in Charge, looked at the signed PNA sheet of paper in their charts which also included the documentation from the local pharmacy re: co-pays. Oh, Jeff Clifton did not like that at all because then the clients with concerns wrote letters asking about the absence of the PNA----letters which he never answered. And so we asked and asked.
And so he called the Buncombe sheriff's department at 7 pm one Sunday evening in February, 2009, and threatened me w/ arrest as I sat with a client rendering therapy.

The purpose of this letter is to ask you how to more exactingly apply the law or even change the law such that the mental health provider may interface efficiently with her clients in keeping w/ NC Mental Health Reform which has as an agenda the movement of mental health services out into the community.

This being said, prior to WNC Homes, there were times when the trash spilled out onto the lawn, the Supervisors in Charge were not paid (their statements), the residents did not receive their PNA, Personal Needs Allowance (what is left over after their co-pays for meds are paid and which is Medicaid 'law'....usually a sum of approx $44/ month), and days when there was no food in the house.

Since WNC Homes took over, there are still problems with residents not dependably receiving their PNA's and more than this, there is a concerted push to not cooperate with Community Support Services which, as you perhaps know, is a Service Definition associated w/ NC Mental Health Reform which was to have taken mental health services into the community. Thus, Brad Owen and Donald Reuss of Western Highlands Network LME (WHN: the old community mental health service people who are now administrators under NC Mental Health Reform) are cc'd in order to keep them updated on these continuing problems and the impact it makes on literally hundreds of clients who receive Medicare/ Medicaid services----which is part of what WHN LME oversees.

I have a one plus inch file now of complaints I have filed on WNC Homes, in February, March, April, 2009, which is regulated by DHSR and the management of that regulation is overseen by DSS Buncombe, specifically, Cheryl Simcox (she is cc'd here). None of these complaints have gone anywhere. The complaints range from: mail stolen; refusal to allow me to speak to my clients on the phone; non-cooperation in providing a ride to the client to appointments, etc.

Of note, the Family Care Home law: "Residents shall receive their mail promptly and it must be unopened unless there is a written, witnessed request authorizing management staff to open and read mail to the resident. This request must be recorded on Form DSS‑1865, the Resident Register or the equivalent;"

There are also HIPAA concerns re: opening of residents' mail. I am not idly stating that this has taken place. Indeed, Cheryl Simcox, her supervisor, Sara Tarpey who works directly w/ the matter of overseeing Family Care Homes in Buncombe county, and Buncombe DHSR employees WITNESSED this fact during a meeting at DSS Buncombe a couple of months ago when Jeff Clifton pulled out a letter I had sent ----in the mail----to a resident of the WNC Homes in Asheville, NC----in order to try and prove to the group in that room----as he had stolen and then copied my letter that had been sent in the US Mail to the resident----- that the schizophrenic resident had no right to ask for a rehearing of his mental competency and his ability to manage his own SSDI check. Since that time, I have continued to advance his desires vis a vis Pisgah Legal Services in Asheville, NC.

So, the proof is already there and was witnessed by about a dozen people during that meeting. Apparently, the resident has to plough ahead with the matter----no matter that he is now homeless and living in the local Mission shelter-----as he had had quite enough of having his mail stolen, etc.

My point: the investigative powers of DSS Buncombe are PITIFUL. Cannot something be done here? I know that DSS is busy and I am sorry to load up their plate w/ yet more work but the lack of ability to adequately investigate matters as per some protecol which allows the Family Care Homes to allow DSS to see what they want them to see is really unacceptable. I have 10+ letters indicating that 'nothing was found' as re: my complaints.

A director at DHSR, Barbara Ryan, wrote me a letter a couple of weeks ago which seemed to indicate that she thinks things are settled. They are decidedly not.

About a week ago, I received a helpful phone call from DHSR's complaint division, Lou Morton that 'our hands are tied' as re: the matter of me being banned from seeing my clients in their homes as 'it is private property.' She inferred that a 'change in the law' is necessary. Thus, I am writing my letter to you (and placing it on my blog) in order to outling whom in the NC State Legislature oversees this law or might be interested in advancing it? What is your role and that of DHSR as pertaining to such an interest?

This is not a request associated w/ just WNC Family Care Homes. There are tens of thousands of people w/ Severe Persistent Mental Health issues residing in these homes, many very rural, across NC. Thus, since we are talking about the law, I am also cc'ing the head attorney of Disability Rights NC.

Given the difficulty w/ working w/ WNC Homes, the Endorsed Provider company working w/ the residents receiving CSS has been advancing clients into Section 8 housing as it becomes available and given that they have mental health diagnoses, ,this housing can be found. This allows them to be more independent and CSS provides them w/ support to move into this role.
And they have more spending money in their pockets----more than $44/ month.

I am fairly familiar w/ the Family Care Home law (Subchapter 13G Licensing of Family Care Homes). I won't go into all the details, but basically here is the problem: I cannot go to this Family Care Home as I am banned from seeing my clients there.

Yes, WNC homes does have a van to take people to appointments. If I schedule clients/ residents to ride in the WNC van, given that the Leicester WNC homes is very rural, they literally sit in the van for hours while other people are carried around. I find it hard to believe that my time with them is that valuable. Clients/ residents who receive Community Support Services (CSS) are helpfully transported to my office in Asheville by the company offering those services. However, not every client receives CSS and thus they are denied mental health treatment (unless I want them to be subjected to hours of travelling around in a van; many of these people have chronic pain problems). In overviewing the Family Care Home law, as you know, these are the sections of that law:

1. overview of physical structure and licensing process
2. staff issues inclusive of qualifications/ training/ training
3. management/ co-administrator qualifications/ duties
4. resident assessment/ care plan; resident services
5. medication management/ self administration of meds, etc.
6. residents' personal funds & management of that
7. policies and procedures
8. use of physical restraints and alternatives
9. rating of the homes (assumably DHSR's role).

In terms of civil rights or residents' rights, here is the broad brush statment that seems to be completely overlooked as re: all these problems outlined above:

"10A NCAC 13G .0908 COOPERATION WITH CASE MANAGERSThe 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. 10A NCAC 13G .0909

RESIDENT RIGHTS: A family care home shall assure that the rights of all residents guaranteed under G.S. 131D-21, Declaration of Residents' Rights, are maintained and may be exercised without hindrance."

I ASKED Buncombe DSS, in a letter to Cheryl Simcox, if, as a clinical psychologist, was I not to be accorded the minimal status of 'case manager' and I never received an answer.

I am asking DHSR to lend assistance to allowing mental health providers to see their clients at the Family Care Homes at the reasonable request of the resident/ client.

Otherwise, Mr. Barrick, what you have is a de facto mini-prison wherein the wardens declare what shall be the rules/ who shall make them/ who shall enforce them/ what they shall eat/ and whom can visit.


Marsha V. Hammond, PhD

********************Here are the e mail addresses of the public officials & attorneys at the legal aid firms in NC who were forwarded this e mail:

lead attorney, Disability rights, NC:,

Family Care Homes DSS Buncombe"Cheryl Simcox, APS, Buncombe DSS "

"Barbara Ryan, chief investi Family HOmes " <>,

"Brad Owen WHN LME " <>,

Piedmont Legal Services, lead attny: "Douglas Sea"

Pisgah legal Aide services, Buncombe county, NC:

NC State Legislature, House: "Susan Fisher"

NC State Legislature, Senate: "Martin Nesbitt" <>,"Martin Nesbitt"

NC State Legislature, House: co-chair along w/ Nesbitt for Joint Legislative Oversight Committee for Mental Health Reform"Verla Insko"

"Nicole Dozier"

DSS Buncombe, Family Care Homes worker: "Sarah Tarpey, Adult Pro Serv, Buncom DSS " <>

NC Department of Health Service Regulation, within NC DHHS: reportedly liason person w/ NC State Legislature:


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