A. To what extent are the appropriate and needed services for people with disabilities available?

Finding:

Source:

1. “Individuals with Traumatic Brain Injury (TBI) indicated they desire more case management and service provider agencies from which to choose. Currently, there is only one agency from which services can be obtained.” § 85% reported the need for case management 2. “…not enough school services and supports available. …the transition from childhood services to adult services is often not a smooth or natural progression.” 3. “Individuals with TBI living in rural areas have very limited access to services and facilities. …have difficulty getting evaluations and assessments in rural areas of the state. In some areas there are no therapists (OT, PT, SLP), life skills trainers, or other professionals trained to work with people with TBI available…lack facilities and professional staff trained in TBI to provide psychiatric, mental health and substance abuse services…unable to access advocacy supports…difficulty obtaining accessible housing.” § 70% reported a need for therapies (PT,OT,SLP, Cognitive) 4. “People throughout the state voiced concern regarding the timeliness of service delivery. Many felt that the wait was too long and requested more timely responses to their requests.” 5. “People throughout the state indicate they are unable to access transportation services. In rural areas, there are no public transportation services or reimbursement for transportation supports.” 72% reported that they need transportation. 6. New Mexico’s institutions are closed: Fort Stanton closed in 1995 and Los Lunas closed in 1997.

1. Long Term Services Division (October 1, 1999). TBI services report to health and human services committee, October 1, 1999 in response to senate memorial 7, of the 99^th special legislative session. Santa Fe, NM: Department of Health 2. LTSD TBI services report, Continued 3. LTSD 1999, Continued 4. LTSD 1999, Continued 5. LTSD 1999, Continued 6. Braddock, D., Hemp, R., Parish, S. and Rizzolo, M. (2000). The state of the states in developmental disabilities – 2000 study summary. Chicago, ILL: Department of Disability and Human Development at the University of Illinois at Chicago.

A. To what extent are the appropriate and needed services for people with disabilities available?

Finding:

Source:

7. Number of people with mental retardation or developmental disabilities living in New Mexico nursing homes is 153 with the annual cost of care at $25,777. 8. “The nation’s leaders in the expansion of community services resources during 1993-98 were New Mexico (249%), Texas (135%), Tennessee (131%), Kansas, (132%), Alabama (122%), and Utah (110%).” 9. “Substantial efforts to finance supported living and personal assistance were evident in 1998 in Alaska, Iowa, Maine, Missouri, New Mexico, North Dakota, Oklahoma and Washington.” 10. “Brokering’ is shorthand for a variety of functions that assist people to deal with the transaction costs of necessary assistance. These functions include: gathering a circle for support, making plans, qualifying for an adequate individual budget, selecting and organizing suitable service providers, and negotiating needed changes. There are many different ways to perform these functions.” 11. “The organization’s services are designed around the identified needs and desires of the persons receiving services, are responsive to their expectations, and are relevant to their maximum participation in the environments of their choice. Efforts to include the person receiving services in the direction or delivery of those services is evident.”

7. Braddock 2000, Continued 8. Braddock 2000, Continued 9. Braddock 2000, Continued 10. O’Brien, J. (2001). Paying customers are not enough: The dynamics of individualized funding. Lithonia, GA: Responsive Systems Associates, Inc. 11. CARF (2000). Employment and community services standards manual. Tucson, AZ: CARF

B. To what extent do key stakeholders perceive that they are receiving high quality services?

Finding:

Source:

1. “Wrap around services need to be extended to include individual and family supports such as individual and group counseling and peer supports…need for training and retraining of individuals periodically through the rehabilitation process. Services should be able to accommodate the intermittent needs of individuals with TBI.” 2. “Providers and family members expressed a need for specialized services for individuals with TBI who have dual or multiple diagnoses.” 3. “…need a broader range of services available…more services for children; respite, and the development of residential services for individuals with aging parents and those who have no family support. Families asked that the age restrictions be lifted from TBI services….throughout the state indicated a need for family respite…few or no resources available to meet ongoing counseling needs.” § 58% are in need of family and individual ongoing counseling 4. “…need for more psychiatric/psychological services, support groups, behavior management, emotional supports throughout the state.” 5. “Individuals who do not meet the current definition for TBI (disabilities as a result of anoxia, stroke, etc.) requested the TBI definition be revisited to consider the inclusion of individuals who have a related disability that is not the result of “an insult to the brain…caused by an external physical force (LTSD Service Definition, 1999).” 6. “More advocates for individuals with TBI…are needed, as well as training for self-advocates.”

1. LTSD 1999, Continued 2. LTSD 1999, Continued 3. LTSD 1999, Continued 4. LTSD 1999, Continued 5. LTSD 1999, Continued 6. LTSD 1999, Continued

B. To what extent do key stakeholders perceive that they are receiving high quality services?

Finding:

Source:

7. “Improvement of the quality of an individual’s services requires a focus on the person and/or family receiving services. The person receiving services participates in decision making and planning that affects his or her life. The service environments reflect identified cultural needs, practices, and diversity. The person receiving services is given information about the purposes of the organization and its ability to meet and address his or her identified strengths, abilities, needs, and preferences.” 8. “Expected results from these (Community) services may include: increased inclusion in community activities; increased or maintained ability to perform activities of daily living; increased self-determination, self-reliance, and self-esteem.” 9. “Instruments devised to collect information regarding consumer and family needs must be ‘user friendly.’” 10. “Individuals with TBI expressed concern about a lack of communication from case managers regarding requested services, accommodations, modifications and service delivery.” 11. “Individuals with TBI need more opportunities for community involvement, socialization and recreation.” 12. 88% reported a need for recreation 13. “A majority of needs assessment participants want more job training and supported employment services for individuals with TBI…need for financial assistance and/or jobs to produce income to make living in the community more manageable. Supported employment services and support need to be expanded …job assessment, placement and job coaching.”

7. CARF (2000), Continued 8. CARF (2000), Continued 9. LTSD 1999, Continued 10. LTSD 1999, Continued 11. LTSD 1999, Continued 12. LTSD 1999, Continued 13. LTSD 1999, Continued

B. To what extent do key stakeholders perceive that they are receiving high quality services?

Finding:

Source:

14. “LTSD was asked to develop a home and community based waiver for individuals with TBI.” 15. “Individuals with TBI and their families need an established process to deal with issues related to the administration of the TBI program including procedures, timelines, denials of requests for services, failure to provide services, and other related administrative decisions.” 16. “Individuals with TBI and their families have difficulty understanding where they are within the system and requested that LTSD develop a tracking system to be used in informing people of status. Individuals with TBI and their families expressed confusion regarding timeliness for action on service requests and service delivery.” 17. To put complexity to work in generating the innovations necessary to support people’s self-determination, policy makers do what they can to harness three interlocking processes: variation, interaction, and selection. § Variation means that many agents pursue different strategies to get what they want in a shared environment. § Interaction makes a complex adaptive system come alive as agents create exchanges, make use of things and inform themselves about other agent’s strategies and thus shape social patterns. § Selection promotes adaptation by determining which strategies should be copied and which strategies should be abandoned.”

14. LTSD 1999, Continued 15. LTSD 1999, Continued 16. LTSD 1999, Continued 17. O’Brien 2001, Continued

C. To what extent are quality direct care providers being recruited and retained in New Mexico?

Finding:

Source:

1. “There is a need for professionals (i.e. physicians, DVR counselors, psychologists, psychiatrists, school personnel, case managers, mental health workers, law enforcement, discharge planners, etc.) to be trained in TBI.” 2. “Direct support staff in community residential settings work for lower compensation and fewer benefits compared to institutional personnel. Community residential service providers must also cope with difficulties in direct service staff recruitment, training and retention. Some states have recently launched initiatives to address low wages to direct service staff.” § In 1999, Arizona appropriated $5 million for a 43 cent per hour increase in community services staff wages. § Maine’s legislature unanimously approved a 1999 appropriation of $2.6 million for an increase in entry wages of direct care workers to $7.99 per hour. § In Pennsylvania, the Legislative Budget and Finance Committee on Wages, Turnover and Quality reported that direct care staff hourly wages of $8.13 were below the federal poverty guideline for a family of four. 3. “The average turnover rate for direct care staff was 32.3%. Albuquerque providers experienced the highest turnover rates with some providers reporting rates as high as 69%, 70% and 82%. Some rural communities reported rates as high as 54% and 62%.” 4. “The average turnover rate for management staff was 14.2%. Two Albuquerque providers reported turnover rates at 50%. A rural provider reported a 45% turnover rate.”

1. LTSD 1999, Continued 2. Braddock 2000, Continued 3. Association of Developmental Disability Community Providers (December 2000). DOH/LFC survey summary. Albuquerque, NM: ADDCP. 4. Association of Developmental Disability Community Providers 2000, Continued

C. To what extent are quality direct care providers being recruited and retained in New Mexico?

Finding:

Source:

5. “…the costs of producing satisfactory assistance more likely rise than decline as the desire for competence and continuity in staff meets the growing scarcity of people interested in providing personal assistance.” 6. The organization’s personnel training program is based on the needs of the persons receiving services; the purposes of the organization; the cultural and socioeconomic diversity of the community served; identified outcomes desired by stakeholders; and applicable governmental laws and regulations.

5. O’Brien 2001, Continued 6. CARF 2000, Continued

A. To what extent are the appropriate and needed services for people with disabilities available?

Finding:

Source:

1. An estimated “1.58% of people living in the US have developmental disabilities. This translates to approximately 27,000 New Mexicans.” 2. 2035 individuals are actively waiting for DD Waiver funding. This number represents “approximately 15% of the potential demand for DD Waiver services”. 3. Possible reasons for the “…large discrepancy between the number of individuals registered for and receiving LTSD services and the potential pool of eligible individuals…” include: · “People with less severe disabilities may not seek services because they are able to function relatively independently and don’t need or want assistance.” · “Some individuals have extensive family and other natural supports that help them live independently.” · “Others receive help from agencies and organizations outside of the LTSD service delivery system…” · “Some are served by other LTSD service delivery programs.” · “Still others may not know about services available to them.” 4. 2160 individuals were served on the DD Waiver at the end of FY 2000 – 13% more than the 1914 individuals served in FY 1999. 5. Some agencies have been praised by accreditation surveyors for seeking funding for unfunded individuals.

1. Long Term Services Division (2000). Fiscal year 2000 annual report. Santa Fe, NM: Department of Health. 2. Long Term Services Division (2000), Continued 3. Long Term Services Division (2000), Continued . 4. Long Term Services Division (2000), Continued 5. Long Term Services Division (Fall, 2000). Note: Current full accreditation reports on file at LTSD. Santa Fe, NM: Department of Health.

A. To what extent are the appropriate and needed services for people with disabilities available? Continued

Finding:

Source:

6. In the “critical variable” “State Level Program Administration”, service providers statewide (total number for each focus group from which responses were summarized: Metro [19], SE [not given], SW [23], NW [12 with 6 additional responses faxed], NE [not given]) commented that commented that: · “Current reimbursement levels do not allow programs to fully meet individual needs, but rather employ a ‘one size fits all technique’” · “Individual Service Plans are tailored to meet documentation and funding, rather than individual, needs.” · “Public information regarding services is not readily available” 7. LTSD Performance Measures: · “Number of customers/registrants requesting and actively waiting for admission to the developmental disabilities Medicaid waiver program.” Fiscal Year 2000 Actual: 2,004 · “Longest length of time for an individual on the waiting list for the developmental disabilities Medicaid waiver program.” Fiscal Year 200 Actual: 64 months 8. Citing results of 7/00 DDPC survey conducted by Virginia Gilmer: “Most often people believed [ISP] plans reflected needs and were followed. However, more than one quarter of those responding did not believe plans reflected needs and more than one third believed that plans were not followed.” (Note: this survey was mailed to all individuals on the Arc New Mexico and Parents Reaching Out mailing lists in July 2000. Parents of persons with developmental disabilities completed 70% of the 107 survey responses received)

6. Somos Familia (November 15, 2000). DDPC needs assessment draft report. Las Vegas, NM: Somos Familia-Family Institute, Inc. 7. Long Term Services Division (2000). Note: Year 2000 LTSD Performance Measure. Santa Fe, NM: Department of Health. 8. Somos Familia (November 15, 2000), Continued

A. To what extent are the appropriate and needed services for people with disabilities available? Continued

Finding:

Source:

9. “New Mexico is one of only seven states that has closed its large state facilities for people with MR/DD”. 10. “…New Mexico ranks in the top ten percent nationwide in terms of per capita spending on individuals with developmental disabilities…” 11. “…85% of individuals receiving DD services are in home and community based services versus ICF/MR care.” 12. “Since 1980, money to fund community services have [has] increased by 2472%.” 13. Somos researchers verbally summarized (1/3/01) these concerns of “Consumers and parents/caregivers” participating in focus groups (Note: held in Farmington [6 parents], Raton [7 day habilitation program participants/1 relative caregiver], Albuquerque [6 parents], Hobbs [8 parents/caregivers] and Anthony [10]): · The waiting list – central registry · Amount of services available in rural areas · Not enough services/choices · Plans when the caregiver can no longer care for the family member (most did not have written plans) · Transition · Lack of services for young adults social life · Wanting to learn to read and write · Language barriers · Fear of INS · Getting the application packet for the waiver 14. An estimated 150 individuals with developmental disabilities reside in nursing homes in New Mexico.

9. Long Term Services Division (2000), Continued 10. Long Term Services Division (2000), Continued 11. Long Term Services Division (2000), Continued 12. Long Term Services Division (2000), Continued 13. Somos Familia (November 15, 2000), Continued 14. Les Swisher, Director PASRR, DOH (Fall, 2000). Note: Verbal response to question.

B. To what extent do key stakeholders perceive that they are receiving high quality services?

Finding:

Source:

1. 25 of 26 agencies achieved the highest level of CARF accreditation (3 years) 2. These strengths and exemplary practices were noted by researchers from a review of surveys of 26 agencies (items listed first were noted in more agencies): · Quality, competence, and dedication of staff · Cultural practices (including bilingual staff, translation and other practices) · Community partnerships and/or winning community support · Financial stability, investments and/or financial innovation · Outcome management systems · Person-centered and family-centered plans; family-driven services · Practices in supporting individuals with behavior challenges · Respecting privacy · Internal service coordination · Assistive technology, dental expertise and outreach · Transition practices (into schools and/or other agencies) · Architectural modifications (to make homes more accessible) · Pictorial and bilingual explanation of rights · Support of individual choice · Consumer satisfaction survey · Benefit coordinator · Confidentiality releases (include time limits) · Policies and procedures · High levels of consumer satisfaction · Commitment to listening to families served · Safety and quality · Family orientation policy and for staff forming close relationships with families · Strong advocacy, personalized services, awareness of rights

1. & 2. Long Term Services Division (Fall, 2000), Continued (Note: accreditation reports are included under this key question as surveys include interviews with/observation of key stakeholders regarding quality of services)

B. To what extent do key stakeholders perceive that they are receiving high quality services? Continued

Finding:

Source:

3. These gaps and deficiencies were noted (as accreditation recommendations and/or suggestions) by researchers from a review of surveys of 26 agencies (items listed first were recommended or suggested to more agencies): · Outcome measurement (improve/expand) · Policies and procedures and forms (create/refine) · Safety, emergency plans and related training (improve/expand) · Accessibility and reasonable accommodations (physical, communication, language, and attitude) · Releases (obtain and put time limits on them) · Fiscal problems · Clear ways for people served to become regular agency employees · Review rights more regularly · Self-advocacy training · Collect and share consumer satisfaction and other information (with consumers and the community) · Make information user friendly for consumers · Expand community employment opportunities and to provide local employers with resources and support in developing employment opportunities · Wage studies (make more objective/review practices) · Expand assistive technology use to enhance consumer community involvement · Clearer criteria for acceptance into services (develop) · Code of ethics to include business and financial areas (develop) · Provide services in safe and healthy environments (for one non-accredited agency) · Follow-up people leaving services

3. Long Term Services Division (Fall, 2000), Continued

B. To what extent do key stakeholders perceive that they are receiving high quality services? Continued

Finding:

Source:

4. “1999 marks the sixth year of the Community System Quality Review of Jackson Class Members.” “In general, this year’s findings did not show as much improvement as hoped. In fact, there appears to be a plateauing in certain planning and service delivery compliance areas.” “A review of the statewide date … from the 1999 Review does not show substantial positive gains overall.” 5. “The New Mexico Developmental Disabilities system continues to provide a high level of quality in the residential programs. Even where staff turnover has been a problem, in most instances, quality of life considerations in the physical environment and the working relationship between staff and individual Class Members is exemplary.” 6. “The most positive changes are seen in the consumer’s lives. Review of the case summary narratives regarding each individual’s circumstance gives a clear picture of the improved lives of the individuals that are served.” 7. Regarding “ISPs Developed by Appropriately Constituted Teams”, compliance dropped from 50% in 1998 to 36% in 1999.

4. Glenn, L.L. (1999). Long term services division 1999 community system quality review. Santa Fe, NM: Department of Health. (Note: review includes interviews/observation of key stakeholders re: quality of services) 5. Glenn, L.L. (1999). Continued 6. Glenn, L.L. (1999). Continued 7. Glenn, L.L. (1999). Continued

B. To what extent do key stakeholders perceive that they are receiving high quality services? Continued

Finding:

Source:

8. “While teams are discussing the [assessment] needs more thoroughly, there is a decrease [in] obtaining the needed assessments.” 9. Case manager training adequacy dropped from 85% (1997) to 81% (1998) to 74% (1999) 10. “Case Manager Understanding of the Person’s Physical Health Needs” dropped from the mid 80’s in 1997 and 1998 to 67%. 11. “Long Term Vision Used as a Basis for Individual Service Planning” dropped from 64% in 1998 to 49%. 12. “Provider Methods, Procedures Relevant to Goals and Objectives to Meet the Person’s Needs” dropped to 14% (1998) and15% (1999) – believe this is related to regional offices no longer reviewing and approving plans. 13. “Total Program Level of Intensity to Meet Person’s Needs” dropped from 66% (1998) to 44% in 1999 as a result of “…continued low level of intensity of many of the small day programs, combined with problems currently in several case management agencies and in certain residential agencies not following through with program recommendations. 14. “Adequate Use of Natural Supports” dropped from 57% (1998) to 51% (1999) 15. “Adequate Community Integration” dropped from 66% (1998) to 55% (1999) 16. “Adequacy of Goals and intensity of Services to Meet Established Goals”: 32% had adequate living goals, 24% had adequate learning/working services and goals, and 20 of 73 individuals had adequate social/leisure goals. 17. “Currently the system is still not meeting persons’ needs in these arenas [adaptive equipment, assistive technology and assessments]” 61% received all needed adaptive equipment; 58% had all needed assistive technology, 42% had all needed communication assessments and services. 18. Blue Cross/Blue Shield utilization review “…has had the effect of lowering the standards and weakening the oversite [oversight] by the Regional Offices for ISP plan compliance and case management services. Regional office staff…no longer have to sign off on these plans before they are implemented.”

8. Glenn, L.L. (1999). Continued 9. Glenn, L.L. (1999). Continued 10. Glenn, L.L. (1999). Continued 11. Glenn, L.L. (1999). Continued 12. Glenn, L.L. (1999). Continued 13. Glenn, L.L. (1999). Continued 14. Glenn, L.L. (1999). Continued 15. Glenn, L.L. (1999). Continued 16. Glenn, L.L. (1999). Continued 17. Glenn, L.L. (1999). Continued 18. Glenn, L.L. (1999). Continued

B. To what extent do key stakeholders perceive that they are receiving high quality services? Continued

Finding:

Source:

19. Citing results of 7/00 DDPC survey conducted by Virginia Gilmer: Question two was “Are you satisfied?” (with the services). Yes-received 41%, yes and no received 12% and no received 47%. (Note: this survey was mailed to all individuals on the Arc New Mexico and Parents Reaching Out mailing lists in July 2000. Parents of persons with developmental disabilities completed 70% of the 107 survey responses received) 20. Citing results of meetings with service providers in 5 DOH regions: In the “critical variable” “State Level Program Administration”, service providers statewide (total number for each focus group from which responses were summarized: Metro [19], SE [not given], SW [23], NW 12 with 6 additional responses faxed], NE [not given]) commented that: · “The person-centered philosophy espoused by the state of New Mexico is not translated into action at all levels of program service delivery: 1. ISD application process 2. Pre-approvals necessary for certain services 3. Waiting lists 4. Lack of flexibility in service provision 5. Timelines of process once placed on waiver 6. No concern for local level impact of decisions made 7. Bias against long-term care and long term maintenance care” · “Rules and regulations change frequently” · “Paperwork to fulfill requirements is burdensome” 21. LTSD Performance Measures: · “Number of abuse, neglect or exploitation allegations in DOH community-based long-term care services that are confirmed by the Division of Health Improvement or substantiated by Adult Protective Service (APS).” Fiscal Year 2000 Actual: 462 · “Percent and number of individual service plans for community-based long-term care programs that contain specific strategies to promote or maintain independence such as daily living skills, work, and functional skills”. Fiscal Year 2001: Developing Baseline.

19. Somos Familia (November 15, 2000), Continued 20. Somos Familia (November 15, 2000), Continued (Note: included as service provider perception of if key stakeholders are receiving high quality services) 21. Long Term Services Division (2000). Note: Year 2000 LTSD Performance Measures. Santa Fe, NM: Department of Health (Note: included LTSD performance measures relevant to high quality of services)

B. To what extent do key stakeholders perceive that they are receiving high quality services? Continued

Finding:

Source:

22. Somos researchers classified concerns of “Consumers and parents/caregivers” participating in focus groups (Note: held in Farmington [6 parents], Raton [7 day habilitation program participants/1 relative caregiver], Albuquerque [6 parents], Hobbs [8 parents/caregivers] and Anthony [10]) parents/caregivers]): Researchers into these categories: · LTSD (knowledge of services, bureaucracy [applying for services], waiting list, access to services, quality of services, inflexibility of system: changes are difficult) · Educational System (knowledge/availability of services, bureaucracy [receiving services], IEP process, service provision [compliance with IEP, unevenness of service provision statewide, lack of specialty service providers, inconvenience of service delivery, eligibility of service [have to prove you’ve regressed to quality for services], transition plans. · Personal/Family Issues (knowledge of issues [medical, social, educational, medical, vocational, financial, psychological], difficulty negotiating system, non-participatory nature of care system planning, concern re: long term quality of life for consumers, planning for the future) 23. Federal Law (originally OBRA the Omnibus Budget Reconciliation Act amended in 1992 and 1998) no longer requires (as of “2 years ago” an annual review of quality of services of people with developmental disabilities who live in nursing homes and New Mexico did not choose to make it a New Mexico requirement

22. Somos Familia (November 15, 2000), Continued 23. Les Swisher, Director PASRR, DOH (Fall, 2000). Note: Verbal response to question.

C. To what extent are quality direct care providers being recruited and retained in New Mexico?

Finding:

Source:

1. These strengths, exemplary practices, gaps and deficiencies related to recruitment and retention were noted (as accreditation recommendations and/or suggestions) in accreditation reports for 26 agencies (items listed first were recommended or suggested to more agencies): · Good staff training programs · Good cultural practices including bilingual, diverse staff · Competent, dedicated staff and/or having low turnover · Retention or recruitment (of respite providers) challenges · Job descriptions need improvement · Performance evaluations need to be completed annually · Expand staff training. · Assure minimum educational requirements met by entering staff · Using incentives for employees (a longitivity study was suggested related to those innovative practices) · Have enough staff consistently available to meet consumer needs 2. New Mexico ranked 49^th in per capita income by state in 1997 and 1998 ($21,164) 3. In 2000, the median family income in the United States was $50,200 and it was $40,800 in New Mexico 4. The counties that had the highest 1999 annual average unemployment rates included: Luna (24%), Mora (17.3%), Taos (12.3%). The counties that had the lowest 1999 annual average unemployment rates included: Los Alamos (1.6%), Union (2.4%)Santa Fe (2.9%),

1. Long Term Services Division (Fall, 2000). Continued 2. Bureau of Economic Research and Analysis (June 2000). New Mexico annual social and economic indicators. Albuquerque, NM: Department of Labor. 3. Bureau of Economic Research and Analysis (June 2000) Continued 4. Bureau of Economic Research and Analysis (June 2000) Continued

C. To what extent are quality direct care providers being recruited and retained in New Mexico? Continued

Finding:

Source:

5. The counties that had the highest rate of food stamp recipiency as of April 2000 included: McKinley (22.5%), Socorro (21.2%), and Torrance (17.4%) 6. The school districts with the highest dropout rates for 1997-1998 included: Española (17.8%), Hatch (17%), and Questa (16.4%) 7. The “fastest growing occupations with over 100 workers in Albuquerque 1996-2006” include: #5 Personal/Home Care Aides (8.6%), #6 Occupational Therapists (8.1%), #7 Physical Therapists (7.4%). Occupational Therapists are also 10^th (6.4%) on the list of the “fastest growing occupations with over 100 workers [in] New Mexico 1996-2006” 8. “Among occupational groups, service occupations will experience the highest growth rates, with food preparation and service occupations accounting for almost half of all new service jobs. The greatest number of new jobs will be found in professional and technical occupations such as engineers, engineering technicians; computer specialists; health practitioners and technicians; and teachers.” 9. “Many of the occupations with the largest number of annual openings have a large numerical base, plus high turnover rates and comparatively low wages”. 10. The National Alliance of Direct Support Professionals (NADSP) states that a low estimate of the number of direct support workers (residential counselor, employment specialist, family advocate, personal support assistant, etc.) nationwide is 2, 127,315

5. Bureau of Economic Research and Analysis (June 2000) Continued 6. Bureau of Economic Research and Analysis (June 2000) Continued 7. Bureau of Economic Research and Analysis (June 2000) Continued 8. Bureau of Economic Research and Analysis (June 2000) Continued 9. Bureau of Economic Research and Analysis (June 2000) Continued 10. Taylor, M. (Undated). National alliance for direct support professionals: Questions and answers about the direct support workforce. Cambridge, MA: Human Services Research Institute

C. To what extent are quality direct care providers being recruited and retained in New Mexico? Continued

Finding:

Source:

11. NADSP recommends these recruitment strategies for direct support workers: · “Link efforts with other community and statewide agencies using common brochures, recruitment materials and marketing strategies.” · “Create structured opportunities for introducing young people to human service careers through: volunteer opportunities; creation of ‘School to work’ programs’ implementing service-learning and other student extra-curricular service efforts; and, encouraging agency tours and visits for your groups and others.” · “Use ‘realistic job previews’ to ensure a good fit between candidate expectations and job reality. These may include videotapes, booklets, work sample tests and structured interviews that give the candidate thorough information about what the job entails.” · “Create incentive programs for existing employees and volunteers to refer friends and acquaintances as job candidates.” · “Take a long-term view of recruitment by fostering ongoing relationships with career placement specialists, guidance counselors, post-secondary educational program staff and others who may direct candidates to jobs.”

11. Taylor, M. (Undated), Continued

C. To what extent are quality direct care providers being recruited and retained in New Mexico? Continued

Finding:

Source:

12. NADSP recommends these retention strategies for direct support workers: · “Implement effective, worker-centered orientation programs that help new hires in overcoming initial work-based learning and socialization difficulties.” · “Provide new hires with mentors who are more ‘seasoned’ co-workers.” · “Provide workers who are in isolated locations with opportunities to network with co-workers.” · “Ensure stability and effectiveness of supervisors.” · “Create flexible benefit programs.” · “Encourage commitment to organizational values and vision through participatory management practices (i.e. ‘team’ decision-making).” · “Assist employees in identifying relevant career paths within the agency and support these paths through competency-based training that leads to a valued credential, wage increments and other forms of recognition.” · “Link agency training with opportunities for higher education and career advancement.” 13. Burnout is lower for staff members “…who are able to consult with supervisors about working or personal problems than for those who thought they could not…”

12. Taylor, M. (Undated), Continued 13. Ito, H., Kurita, H. and Shiiys, J. (December 1999). Burnout among direct-care staff members of facilities for persons with mental retardation in Japan. Mental Retardation. Vol. 37 (6), 477-481.

C. To what extent are quality direct care providers being recruited and retained in New Mexico? Continued

Finding:

Source:

14. “In other national studies investigators have reported average annual turnover rates for community settings in the 50% to 70% range…”. 15. “Importantly, as in other studies…recruitment surpassed turnover as the most commonly reported problem facing residential managers.” “…recruitment and retention challenges are inextricably linked, so problems in one area put heavy pressure on the other…” 16. “Between June 1991 and June 1997, the number of people with developmental disabilities in residential settings with six or fewer residents increased by over 86,000, nearly 80%…” 17. “Although much can be done to improve recruitment and retention with agencies and individual homes, little of it holds much promise without wage and benefit structures that provide direct support professionals with decent compensation for the important work they do. Compensation must be viewed more broadly than traditional wage and benefit packages. Providing flexible benefit packages … offering items such as child care or transportation…state legislatures need to…support significant alternative benefits, such as tuition credits for public college and university based on hours worked…and other direct benefits. The resources for adequate compensation must also derive in part from reforms that enhance productivity by reducing administrative and rule-dictated expenditures …” Other ideas discussed included: career lattices, training for supervisors, rewards for skills, networking for recruitment resources and opportunities, tie into welfare to work/school to work resources

14. Larson, S.A. and Lakin, K.C. (August 1999). Longitudinal study of recruitment and retention in small community homes supporting persons with developmental disabilities. Mental Retardation. Vol. 37 (4), 267-280. 15. Larson, S.A. and Lakin, K.C. (August 1999), Continued 16. Larson, S.A. and Lakin, K.C. (August 1999), Continued 17. Larson, S.A. and Lakin, K.C. (August 1999), Continued

C. To what extent are quality direct care providers being recruited and retained in New Mexico? continued

Finding:

Source:

18. “High turnover still exists at the direct care level and in one case management agency. Pre-service and in-service training, as well as supervision, has not been adequate to prepare the new staff to meet the needs of persons served. New strategies are needed in local communities where there is low unemployment and/or an inadequate employee pool.” 19. “Reviewers found high turnover in some case management agencies, and new case managers given a caseload without the appropriate pre-service and in-service training.” 20. “Another topic of concern was that of low reimbursement rates to service providers, with the resultant low pay, high turnover, and the lack of adequate training for direct care staff in the communities.” (Note: 7/00 DDPC Public hearings conducted by Virginia Gilmer in Las Cruces, Santa Fe, Albuquerque, Gallup and Roswell. A total of 37 people participated) 21. In the “critical variable” “Local Level Program Administration”, service providers statewide (total number for each focus group from which responses were summarized: Metro [19], SE [not given], SW [23], NW 12 with 6 additional responses faxed], NE [not given]) commented that: · “Recruitment, training, and retention of staff is a major problem” · “Low pay makes it difficult to recruit and retain qualified staff” 22. In the “critical variable” “Local Level Program Service Delivery”, service providers statewide total number for each focus group from which responses were summarized: Metro [19], SE [not given], SW [23], NW 12 with 6 additional responses faxed], NE [not given]) commented that: · “Retention of staff at the direct care level is a major concern” · “Low pay makes it difficult to recruit and retain qualified staff”

18. Glenn, L.L. (1999). Continued 19. Glenn, L.L. (1999). Continued 20. Somos Familia (November 15, 2000), Continued 21. Somos Familia (November 15, 2000), Continued 22. Somos Familia (November 15, 2000), Continued

C. To what extent are quality direct care providers being recruited and retained in New Mexico? continued

Finding:	Source:
23. “Percent of community long-term services contractors’ direct contact staff who leave employment annually”: Developing baseline through initial survey – data was due November, 2000	23. Long Term Services Division (2000). Note: Year 2000 LTSD Performance Measure. Santa Fe, NM: Department of Health

Highlighted Findings:

There is a very large discrepancy between the total numbers of people on the Central Registry (waiting list) combined with the total number being served as compared with the projected incidence of people with developmental disabilities in New Mexico. By that projection, only 15% of the population is identified through service/wait list.

New Mexico is one of the national leaders in per capita spending on individuals with developmental disabilities and for having closed institutions.

Comments by providers and consumers indicate that there is a discrepancy between ISP policy and the reality in people’s lives.

Length of wait on the Central Registry can be as long as 5.3 years.

The estimated 150 individuals with developmental disabilities who live in nursing homes no longer receive an annual review of their quality of service.

The Long Term Services Division has recently collected recruitment and retention information from providers. It could be interesting to compare high and low staff retention rates to factors such as economic indicators for a given county.

Review of Current full accreditation reports on file at Long Term Services Division, Department of Health:

In the past, the Long Term Services Division has required that agencies provide proof of current accreditation but not necessarily a full copy of the current report. Only a minority of agencies (less than one third) has full reports on file with LTSD.

The possible CARF accreditation outcomes that community agencies may achieve include: Three-Year, One-Year (an organization may not be awarded a consecutive one-year accreditation), Provisional (the organization has to achieve a three year accreditation at the end of the provisional accreditation or it will be non accredited), and Non-accreditation (indicates major deficiencies). Of this sample of 26 agencies, only one agency surveyed by CARF failed to achieve certification; the other 25 achieved three-year accreditation.

Review of reports currently on file indicate that the surveys could be a rich source of information for identify where specific best practices exist and how those best practices might be linked with corresponding needs identified in other agencies. For almost every need identified by surveyors, another agency had a related practice noted as a strength or exemplary practice.

Trends could also be drawn from analysis of accreditation surveys. For example, in this small sample, one theme was that many staff members were dedicated and competent.

While using a roughly similar format, the depth of detail in the reports and insight into exemplary practices of the CARF surveys seemed to depend on the individual surveyors who prepared the report.

Only one full Accreditation Council report was available in these records.

“State of New Mexico, Department of Health Long Term Service Division 1999 Community System Quality Review”:

The 1999 State of New Mexico, Department of Health Long Term Service Division 1999 Community System Quality Review” showed decline in important areas related to quality of services for the first time in the six years the review has been completed in New Mexico. It will be important to see if this trend has been reversed in the 2000 review, which is being compiled.

It would be useful to compare CARF accreditation survey outcomes with Community System Quality Review outcomes as the CARF survey has a comprehensive programmatic focus and the Community System Quality Review is focused on specific individuals. In briefly comparing agencies who had both CARF survey reports and the Community System Quality Review, in some, the community review appeared to match CARF survey (and non-accreditation) concerns (such as high turnover, lack of training), in others, the Community System Quality Review offered deepened comments about issues that were much more briefly touched in the CARF survey. Interestingly, some agencies identified by the Community System Quality Review as being problematic had achieved the highest CARF accreditation (three-year) with specific strengths and recommendations noted.