Maine State Library Maine State Documents Developmental Disabilities Council 2012 Report of the Work Group Pursuant to Resolve, Chapter 80 "To Develop a Plan to Improve Public Guardianship Services to Adults with Cognitive Disabilities" Maine Developmental Disabilities Council Public Guardianship Work Group Follow this and additional works at:http://statedocs.maine.gov/ddc_docs Recommended Citation Maine Developmental Disabilities Council and Public Guardianship Work Group, "Report of the Work Group Pursuant to Resolve, Chapter 80 "To Develop a Plan to Improve Public Guardianship Services to Adults with Cognitive Disabilities"" (2012). Developmental Disabilities Council.Paper 3. http://statedocs.maine.gov/ddc_docs/3 This Document is brought to you for free and open access by Maine State Documents. It has been accepted for inclusion in Developmental Disabilities Council by an authorized administrator of Maine State Documents. For more information, please [email protected]. Report of the Work Group pursuant to Resolve, Chapter 80 “To Develop a Plan To Improve Public Guardianship Services to Adults with Cognitive Disabilities” Submitted by: Maine Developmental Disabilities Council On behalf of the Public Guardianship Work Group For additional Information, please contact: Julia Bell, Executive Director 139 State House Station Augusta, Maine 04333-0139 [email protected] DEVELOPMENT OF PLAN TO IMPROVE GUARDIANSHIP FOR ADULTS WITH COGNITIVE DISABILITIES A Report prepared pursuant to Resolve, Chapter 80, 125th Legislature Presented to the Joint Health and Human Services Committee I. Introduction During the first session in 2011, the 125th Legislature enacted Resolve, Chapter 80, “To Develop a Plan To Improve Public Guardianship Services to Adults with Cognitive Disabilities.” This Resolve directed the Maine Developmental Disabilities Council to convene a stakeholder group to develop a working plan for a program for the transition of public guardianship responsibilities for adults with cognitive disabilities from the Department of Health and Human Services to an entity independent of that agency. The Resolve directed that the development of the working plan should include consideration of models for provision in other states which separate public guardianship responsibilities from service coordination. The stakeholder group was directed to develop recommendations for the model that would be most appropriate for Maine to adopt, and to provide those recommendations and a working plan for transition to this model to begin July 1, 2012. The Resolve also specified that the report should identify any necessary statutory changes to enable implementation of the recommendations, and the fiscal impact of those changes. As part of its work, the stakeholder group was also asked to consider and provide information in its report regarding the feasibility of merging the volunteer correspondent program, which is currently administered by the Maine Developmental Services Oversight and Advisory Board, into the proposed model for public guardianship. Although the resolve identifies the population group under public guardianship as adults with “cognitive disabilities,” the list of organizations to be included in the stakeholders’ group and the assignment to the Developmental Disabilities Council led the group to assume that the target group was persons with intellectual disabilities or autism who are eligible for services under Title 34-B, Chapters 5 and 6. This was the focus of the stakeholders’ deliberations. However, as noted in the Recommendations section of this report, the key components of a public guardianship program that will assure high quality, effective services are delivered are applicable to provision of these services to the broader population of persons in Maine who may need this support. II. Description of Stakeholder Group and Process Resolve, Chapter 80 identified specific organizations that should be invited to participate in the stakeholder group to develop a working plan for transition of guardianship responsibilities for persons with cognitive disabilities to an agency separate from the Maine Department of Health and Human Services. The Maine DD Council (MDDC) contacted each of those organizations to invite their participation in the stakeholder group, and also provided information to other entities that expressed interest in the work that was to be undertaken by the group. All of the organizations named in the Resolve sent representatives to the initial meeting of the group in July, 2011. While some of the representatives changed during the series of meetings and some were unable to participate in every meeting, meeting notes were circulated to all participating organizations and input was provided and incorporated in the subsequent deliberations of the group. Most organizations participated in-person in each of the thirteen meetings that were held from July, 2011 through January, 2012. The Stakeholder Group included representatives of the following organizations: Disability Rights Center of Maine Maine Association for Community Service Providers Maine Developmental Disabilities Council Maine Developmental Services Oversight and Advisory Board Maine Probate Judges Assembly Maine State Employees’ Association Office of Adults with Cognitive and Physical Disabilities Services (OACPDS) in the Maine Department of Health and Human Services (DHHS) Office of Advocacy, Maine DHHS Office of the Attorney General** Speaking Up For Us of Maine **Note: Two representatives of the Office of the Attorney General participated in the meetings and provided information regarding legal considerations of the issues discussed, they did not express opinions on the policy issues discussed or participate otherwise in the formulation of recommendations. The stakeholders’ group collected and considered information regarding the administrative structures for provision of guardianship services for both the Adult Developmental Services program and in the Office of Elder Services for elderly persons and other persons with disabilities served by that office. During the tenure of this stakeholder group, the Maine DHHS undertook a reorganization of guardianship duties for persons served by Adult Developmental Services to transfer and incorporate that responsibility to the Adult Protective Services unit within the Office of Elder Services. The stakeholder group was provided with information regarding this reorganization and incorporated this in its deliberations. The stakeholder group also identified specific information to be collected regarding diverse administrative structures in other states for delivery of guardianship services, especially for persons with disabilities. Initial information regarding services in other states was collected by MDDC staff and members of the stakeholder group, and specific states were then selected to be evaluated in greater detail. Members of the group contacted some of the selected states to collect additional information. The group also arranged for a presentation via teleconference by a representative of the independent agency in New Hampshire that is responsible for public guardianship through a State contract. Findings and recommendations were determined with input from all stakeholders in the group. In some instances noted in this report, specific information and wording were provided by one of the group members. III. Description of Current Administrative Structure for Maine DHHS Guardianship Services for Adults The separate administrative structure for provision of guardianship services for persons eligible under MRSA Title 34-B, Chapters 5 and 6 was established many years ago within the state agency that administered developmental and behavioral health services. This separate structure remained after the consolidation of the Department of Behavioral and Developmental Services and the Department of Human Services into one state agency in 2005, and was still the status quo at the time last year that Resolve Chapter 80 was passed by the Legislature and signed by the Governor. Under this structure, the state employee within Adult Developmental Services assigned responsibility for case management services, known as the Individual Support Coordinator (ISC), also served in the role of public guardian. The administrative structure established and reinforced by Consent Decrees related to services for persons with intellectual disabilities and autism specified a caseload of no more than 35 consumers for each ISC, and specific duties on behalf of those consumers under public guardianship were absorbed within the ISC’s workload. Concern had been raised previously by advocates and was brought up during the stakeholder group’s meeting regarding the potential conflict inherent in the same state employee serving in the role of guardian (and therefore the individual’s primary advocate) and also as the Individual Support Coordinator representing the state agency. Additional information was solicited from the Office of Public Guardianship (OPG), OACPDS and the Office of Elder Services (OES), as well as advocates. Since the date of the passage of this Resolve, there have been significant changes in personnel in the offices currently responsible for public guardianship of persons served by the Office of Adults with Cognitive and Physical Disabilities Services (OACPDS). Over forty percent of the state Adult Developmental Services staff in OACPDS have left over the past several months, and a transition to community case management services begun more than two years ago has continued. There has also been some restructuring of services within the state agency in anticipation of additional changes. The following description of the restructuring underway within the Maine DHHS was provided by representatives of that agency who were members of the stakeholder group for this report: The consolidation of the public guardianship and conservatorship programs of the Office of Adults with Cognitive and Physical Disabilities with that of the Office of Elder Services began in the fall of 2011. The initial restructuring places the management and supervision of both the Adult Protective Services Program and Public Guardianship and Conservatorship Program under the Director of Adult Protective Services, Karen Elliott. For the first time, these programs are unified and the goal is to have these programs operate and respond in a consistent manner. Estate Management is an essential component of this program and staff from both Offices will be reporting to Probate Courts and managing assets in the same manner. This restructuring provides protected persons with consistent and transparent asset management and Court reporting. The Department is committed to separating the case management function from the public guardianship function. However, the timetable for accomplishing this goal is dependent upon the specifics of anticipated, but not yet announced, Departmental reorganization. Further restructuring will continue as DHHS responds to the ever increasing needs of the persons served for case management. To the extent possible, DHHS will look to continue referrals to Community Case Management agencies and separate the role of case manager from that of Public Guardian and/o Public Conservator representative. IV. Review of public guardianship models in other states The workgroup learned that administration of public guardianship programs varies widely among states due (but not limited to) to a variety of factors such as differing structures of probate courts, county versus state funding of health and human service programs and history of litigation and class action settlements. Guardianship programs in New Hampshire, Washington, Kansas, New Mexico and Cook County, Illinois were identified as having high quality or unique public guardianship programs or features. State/Other Administrative structure Notable characteristics Stakeholder Group Notes Government Unit Kansas Public instrumentality Longstanding, effective Volunteer program does not replace administers a statewide statewide volunteer public guardianships: program volunteer program that guardianship services. completely, as it lacks thecapacity to recruits, trains, and supports adequately serve persons with certain private guardians for persons high level needs. who would otherwise have Serves persons with all types of public guardians functional needs (i.e. developmental disabilities, mental health disorders, frail elderly, etc.) Estimated costs $ 2 per person per day New Hampshire State contracts with private Most“public guardianship” Concern regarding cost agencies to provide functions are contracted out, Serves persons with all types of guardianship services excluding the filing of functional needs (e.g. frail elderly, guardianship petitions, which is developmental disabilities, mental done by the state agency health disorders, , etc.) Estimated costs of $7 per person per day State/Other Administrative structure Notable characteristics Stakeholder Group Notes Government Unit New Mexico Office of Guardianship Provides publicly-funded All public guardianship functions for housed under umbrella of contracts for “corporate adults managed by this office. New Mexico Developmental guardians” and legal services, Waiting list maintained for services – Disabilities Council which include Petitioning dependent upon appropriation in State Attorney, Guardian Ad Litem budget. (GAL), and Court Visitor Washington Office of Public Guardian Pilot program since 2007 in six a) Model not a good fit with the resides in judicial branch of counties, with outcome data structure of and resources state government and available available to Maine probate courts. contracts with regional b) Serves persons with all types of providers. functional needs (e.g. developmental disabilities, mental health disorders, dementia, etc.) Additional information regarding each of these guardianship programs can be found at the following websites: Kansas: http://www.ksgprog.org/ New Hampshire: http://opgnh.com/ New Mexico: http://www.nmddpc.com/page/office-of-guardianship Washington: http://www.advocateresourcecenter.org/oppsguide/organization.192507- Washington_State_Office_of_Public_Guardianship