This agreement is effective from May 2, 1992 through May 2, 1993. This agreement can be terminated by either party in writing. However, the party wishing to terminate the agreement must give a clear description as to what the problem(s) are four (4) weeks before terminating the agreement. They must also allow the other party an opportunity to respond in writing as to how they feel the problem(s) may be resolved. This agreement may be extended after May 2, 1993 for a specific time period in writing and signed by both parties.

The ENDependence Center agrees to the following:

1. To provide peer counseling to appropriate residents of Lake Taylor Hospital.
2. To provide group counseling to appropriate residents at Lake Taylor Hospital.
3. To provide sensitivity training to the staff of Lake Taylor Hospital no less than once a year and no more than three (3) times a year.
4. To attend four (4) resident council meetings to assist when necessary.
5. To provide tickets to community activities/events when available at no cost to participants.

Lake Taylor Hospital agrees to the following:

1. To provide space in the residents' dining room for group counseling.
2. To provide space in the family room on the Azalea Pavillion for peer counseling.
3. To allow the peer counselor to use the telephone in the recreation therapist's office.
4. To announce over the public address system the day, time and place of the group counseling session.
5. To write the day and time that the peer counselor will be at Lake Taylor Hospital on the monthly activity calendar, monthly group counseling meetings only.

Resolution of any conflicts or any potential conflicts between Lake Taylor Hospital and the ENDependence Center, Inc. will be brought to the attention of the Director of Participant Services at the ENDependence Center, Inc. and the Director of Social Work at Lake Taylor Hospital. If a situation were to arise that cannot be resolved by the principle supervisory staff, then the concern(s) will be forwarded to the chief Administrator of each of the facilities.

__________________________________________
Administrator                                                         Date
Lake Taylor Hospital

__________________________________________
Stephen L. Johnson                                               Date
ENDependence Center, Inc.

D. Community Services Program for Persons with Physical Disabilities
Amended Work Statement

For the Period July 1, 1994 to June 30, 1995

Submitted to
Commonwealth of Pennsylvania
Department of Public Welfare
Harrisburg, PA

Liberty Resources, Inc.
(formerly Resources for Living Independently)
One Winding Way Suite 108
Philadelphia, PA 19131
(215) 581-0666

For additional information contact:
Linda Staroscik
Program Manager

I. Overview

For FY 1994-95, Liberty Resources will continue to provide the four mandated functions which include the administration of the Annual Resident Review (CRD's), the administration of the CSPPPD, the provision of services under the Medicaid Home and Community Based Waiver Program and the functions of the Administrative Entity. These four mandated functions will be provided through Liberty Resources' Philadelphia and Allentown offices. All functions except those of the Administrative Entity will be provided to the northern part of the Northeast region through subcontract with the Northeast Pennsylvania CIL.

III. Objectives and Methodology

Objective 1.

    To conduct 20 on-site comprehensive (previously called full) and 557 follow up comprehensive (previously called partial) CRD's between July 1, 1994 and June 30, 1995 in all counties comprising the southeastern and northeastern regions and in compliance with federal, state and OSP requirements and to render final determination decisions which meet OSP standards in a timely manner.

Objective 2.
To explain OSP's final determination decisions to nursing home applicants.

Objective 3.
To bring specialized services to consumers in nursing homes who are preparing to relocate to the community in the near future or in subsequent years, who are undecided about relocating or who wish to remain in the nursing facility and receive specialized services to maximize self-care and self-actualization skills.

Provide Specialized Services to Consumers in Nursing Homes

    Liberty Resources and its subcontractors will work with nursing facilities in the southeastern and northeastern regions to bring specialized services to eligible consumers who choose to participate in the program.

Consumers Preparing to Relocate

    Consumers who are preparing to relocate to the community will work with their service coordinator to develop a Specialized Services Plan which will integrate specialized services with those services provided by the nursing home. The service coordinator will work with nursing home staff to schedule attendance at plan of care meetings. The consumer will work with the service coordinator to identify a community support team, or will continue to work with their community support teams if such a team has already been formed. New consumers will be assisted in developing realistic goals and objectives with realistic time frames. For consumers who already have personal support plans, assistance will be given in reviewing and if necessary refining goals, reviewing progress and identifying necessary next steps. The consumer, service coordinator and community support team members will assume responsibility for carrying out specific tasks noted in the personal support plan in order to help the consumer reach the goal of relocation. Service coordinators work individually with each consumer assisting him or her to identify a community support team and to develop a personal support plan. Service coordinators also assist consumers in directing their community support teams and in taking control of the services they receive. As a result, goals and objectives and corresponding services are individualized to the needs and choices of each consumer.

    Those consumers who are planning to relocate in FY 94-95, will be assisted in making sure that housing applications have been filed. Service coordinators will work with housing advocates and with housing consultants to assist consumers to identify accessible housing, to get on housing waiting lists, and to complete paperwork for Section 8 subsidies and other housing subsidy programs. Consumers will participate in skills training classes based on individual assessments of each consumer's need for specific areas of skills training. Peer support and peer mentoring will be provided through the CSPPPD Community Advocates program. Service coordinators will assist consumers with financial management, locating a bank, arranging for change of address for Medical Assistance, Social Security, magazines and other subscriptions, with enrollment in the Medicaid Home and Community Based Waiver Program and referrals to the Office of Vocational Rehabilitation (OVR) for services. In cases in which OVR support is denied, the CSPPPD service coordinator will explore alternative sources of funding. The CSPPPD will assume the cost of providing the equipment or service only as the payor of last resort. The service coordinator will not requisition payments for wheel chairs and other equipment from Medicaid, while the consumer is in the nursing home because equipment purchased by Medical Assistance for nursing home residents belongs to the nursing home and cannot be taken to the community by the consumer. Since a consumer's success in relocating depends upon functional and community mobility made possible by having a motorized wheel chair, the service coordinator will work with private agencies, such as the Multiple Sclerosis and Muscular Dystrophy Societies, to purchase equipment not available through government programs.

    Once a suitable apartment or home is located, the service coordinator will work with the consumer to arrange for an occupational therapist to visit the apartment and make recommendations for minor adaptations such as ramps, accessible light switches, environmental control units, shower chairs, door handles, telephones, pull cords and other equipment.

    The consumer will be assisted in planning for the move, arranging for personal assistance services, having medical records transferred to a physician in the community, securing a week's or preferably a month's supply of medication, setting up an appointment with a physician in the community, identifying a local pharmacy that accepts Medicaid and delivers, and securing a grant or loan from the CSPPPD Grant and Loan Fund for reimbursable and nonreimbursable expenses associated with the move. Since it takes approximately six weeks for consumers to receive their Social Security checks after the move, consumers, who have no other source of income need funds to cover living expenses, pay rent and utility deposits, purchase food, cover transportation costs, and buy household items during the transition. Consumers will be assisted through this transition period with funds from the CSPPPD Grant and Loan Fund.

    Consumers are assisted in establishing informal support networks and where supportive family exists, encouraging that support. The Community Advocates Program, cross disability support groups, trauma support groups, women's groups and Liberty Resources' community integration activities assist consumers in their efforts to build informal linkages in the community.

    Consumers are also assisted by their service coordinators in preparing for emergencies. Consumers are encouraged and are trained to take primary responsibility for providing emergency backups for personal assistance services and for acting appropriately in emergencies. Often, 24 hour emergency coverage is provided by housing management through pull cords and buzzers in each apartment. In the absence of such coverage, consumers are assisted in arranging for 24 hour emergency call coverage by vendors in the community. In addition, Liberty Resources management staff carry a page unit that provides 24 hour emergency coverage for TIL consumers.

    Consumers are assisted by service coordinators, training staff, peer support staff and by the Community Advocate Program in advocating for themselves. They are encouraged to identify discriminatory treatment and to demand corrective action.

    Consumers will be assisted in their relocation before, during and after the move. The service coordinator will visit the consumer on the day of the move if the consumer chooses or will check by telephone to assure that all arrangements have been made, that attendant care services have started and that equipment such as hospital beds, shower chairs and Hoyer lifts have been delivered.

    The service coordinator and the consumer will then follow the monitoring plan agreed upon in the personal support plan. This plan may involve weekly, biweekly or monthly visits. The monitoring plan is renegotiated as the consumer settles in.

    Consumers relocating in subsequent fiscal years will be provided with specialized services. Time frames for goal completion will be extended and training will address the skill needed by consumers who are preparing for community living.

    Consumers Who Are Undecided or Not Moving From the Nursing Home

    All eligible consumers will develop a Specialized Services Plan with their service coordinators. These plans will integrate specialized services provided by the CSPPPD contractor with those provided by the nursing home. The service coordinator will work with nursing home staff to schedule attendance at plan of care meetings and to assure integration of services. Specialized Services Plans will be filed at the nursing facility. Specialized services such as training, community integration activities and peer support will be offered along with other services requested by and shown to be a need for the consumer. Consumers will work with their service coordinator to plan and participate in activities. Additionally, Liberty Resources will work with nursing home administration and staff to sponsor joint activities for the benefit of consumers.
 

    Specialized Services

    Specialized services that have been offered by Liberty Resources and that will be offered under the terms of this proposal will be based upon consumer need and choice and include:

    Service Coordination
    Peer Support/Peer Mentoring
    Skills Training

self-empowerment	women's retreats
home management	Planned Parenthood training
personal management	leadership training
financial management	decision making training
managing your personal attendant	ADA and civil rights for persons with disabilities
rights and responsibilities	prevocational training
nutrition and meal preparation	self-defense
identifying and applying for subsidized housing	victim assistance
community mobility	computer skills
communication skills	fire safety
time management	personal safety training and follow up crisis counseling
use of leisure time	housing
human sexuality	attending national and state independent living conferences

Objective 4.

    To administer a Medicaid Home and Community Based Waiver for consumers relocated from nursing homes to community settings.

    4.1 To serve as the administrative entity for the southeastern and northeastern regions of Pennsylvania. In this capacity the Liberty Resources Center will:

Objective 4.2

    To be a provider of waiver services.

Methodology

    Liberty Resources is enrolled as a provider of services under the waiver. The services to be provided by Liberty Resources are resource management, routine wellness, skills training, peer support, and community integration activities.

Waiver Services

    Liberty Resources and its subcontractor, the Northeast Pennsylvania CIL, will provide waiver services in all waiver covered counties in the southeastern and northeastern regions.

    Waiver services that will be provided, according to individual consumer need, are habilitation services, respite services, resource management services, and other services.

    Consumers will be given the opportunity annually to select their service providers from a list of qualified waiver providers.

In-Home Habilitation Services

    In-home habilitation services include daily living services and related training, e.g., personal assistant services, homemaker services, routine wellness, and community integration services such as skills training, peer support and community integration activities and field experiences.

    Personal assistant and homemaker services are available in all Pennsylvania counties either through county programs or home health agencies. Liberty Resources will recruit providers of personal assistant, homemaker and routine wellness services in all covered counties and will provide training and technical assistance to agencies requiring such service to bring them up to standard.

    Liberty Resources and its subcontractor, the Northeast Pennsylvania CIL, will provide daily living services, home support services, routine wellness, skills training, peer support and community integration opportunities in all covered counties. The Lehigh Valley CIL is enrolled as provider of skills training under the waiver. In remote areas of the regions served, Liberty Resources will recruit the Berks County CIL and the Anthracite Region CIL, UCP affiliates, attendant care providers, and individual skills trainers and peer counselors.

Out of Home Habilitation

    Out of home habilitation consists of day programs, supported employment, prevocational and educational services. Liberty Resources will recruit waiver providers which offer out of home habilitation services. Typically, UCP affiliates, the Easter Seal Society and community mental health/mental retardation agencies administer adult day programs. There are a number of agencies such as Supportive Employment Services, which offer employment and prevocational opportunities. Teachers, trainers and tutors will be recruited to provide education services.

Respite Services

    Providers of respite services will be recruited to serve those consumers who live with family or in small dispersed OSP approved Domiciliary or Personal Care Homes. Respite services, consisting of 24 hour care or temporary or emergency care for less than 24 hours, will be provided in the consumer's home or in a family setting approved by OSP. It has been the experience of Liberty Resources that attendants often can provide respite care in either the consumer's or the attendant's home. Liberty Resources will recruit attendants to provide respite services.

Resource Management Services

    Resource management services will be provided by Liberty Resources and the Northeast Pennsylvania CIL resource managers and by resource managers recruited by the Liberty Resources or via other qualified waiver providers. Liberty Resources will recruit resource managers in all counties served including remote areas and will train and provide technical assistance to new providers.

Other Services

    The other service categories under the waiver include: specialized therapies such as physical therapy, occupational therapy, speech therapy, visual therapy, and behavior therapy; visiting nurse services, minor physical adaptions to family or consumer homes and transportation. Providers of special therapies and visiting nurse services will be recruited from agencies, professional organizations, and through the recommendations of OVR, rehabilitation hospitals, and area agencies on aging. Contractors to provide minor physical adaptions will be recruited through recommendations from OVR, rehabilitation hospitals and the Better Business Bureau. Providers of transportation will be recruited from licensed private and public carriers and possibly UCP affiliates serving all areas of the southeastern and northeastern regions. Although, providers of transportation are exempted from waiver training, Liberty Resources will encourage some minimal training to sensitize drivers to physical and attitudinal barriers which consumers encounter.

Provision of Non Waiver Services

    All services required by consumers to live in the community are not covered under the waiver. Such uncovered services include payment for utilities, telephone service, home improvement, personal items, and special education services. In order to be provided to the consumer, these services must be shown to be essential to the consumer's health, welfare and safety and meet goals outlined in the personal support plan.

    With regard to room and board, Liberty Resources will assist consumers in securing federally subsidized housing and will not as a rule pay room and board. Liberty Resources will, on a case by case basis, consider the possibility of long term loans to some consumers who move to the community and are awaiting Section 8 Certificates. Resource managers work with consumers to secure all federal and state entitlement programs so that each relocated and relocating consumers' finances are in order and are stable. There are times, usually this is a six week period during the transition from nursing home to community, when Social Security checks do not come to the consumer because of time required for the change of address order to be put into effect. In these cases, in cases of emergency and to cover non-reimbursable expenses such as household expenses, Liberty Resources through the CSPPPD, maintains a Grant and Loan Fund which is self sustaining through the repayment of loans. For those under twenty one years of age, Liberty Resources will try to access special education services through the intermediate units of the consumer's school district and home improvements through OVR or through charitable organizations such as Christmas in April.

Objective 5.

    To arrange for the relocation of nursing home residents and provide specialized services to relocated residents who are not eligible for waiver services or are awaiting enrollment in the waiver.

Methodology

    Service coordinators work with consumers, their community support teams and area housing agencies and service providers in assisting consumers to identify and secure appropriate housing. Service coordinators coordinate with the OVR to avoid duplication of effort, to secure support for skills and vocational training, peer support, vocational opportunities and equipment. Consumers are assisted by service coordinators in applying to their Social Security client representatives for approval of Plans for Self-Sufficiency (PASS). Consumers are assisted by their service coordinators in arranging for personal assistance services or homemaker services, community mental health\mental retardation service and the services of other community agencies. Specialized services include, but are not limited to, skills training, peer support, opportunities to visit local and inter-regional housing sites, and community integration activities. Service coordinators assist consumers in applying to the Grant and Loan fund to cover moving costs until consumers begin receiving their SSI and SSDI payments. Grants are negotiated to cover the cost of nonreimbursable services while loans are negotiated to cover the cost of reimbursable services. Service coordinators assist consumers in changing their addresses with Social Security, Medicaid, banks, and for telephone service and subscriptions. Service coordinators assist consumers in locating banks, pharmacies and physicians' offices close to where they will be moving and in arranging for minor home adaption and emergency call equipment, if they are needed.

    Since consumers are not eligible for waiver services until they move to the community, the service coordinator works with the consumer to secure all needed information so that eligibility determinations can be made by the county assistance office and invoicing for waiver services can begin as promptly as possible after the move to the community. Specialized services are provided in accordance with personal support plans to consumers who are awaiting enrollment or to those who are not waiver eligible.

    Specialized services for waiver and nonwaiver consumers are similar, differing only in source of funding. For both groups of consumers in the community, specialized services consist of a package of services individualized to consumer need such as personal assistance services, homemaker service, skills training, peer support, community integration activities, day programs, transportation, educational and vocational opportunities, resource management and equipment purchase.

    Service coordinators visit consumers within a week of the move, update service plans, as needed, and continue to carry out the monitoring plan outlined in the personal support plan. Service coordinators conduct periodic reevaluations to determine continued eligibility for CSPPPD services.

    Specialized services will be provided to all CSPPPD eligible consumers whether in nursing homes or in the community regardless of geographic location. Liberty Resources will also work with consumers to locate housing desired by the consumers in counties and regions other than the consumer's current county or region of residence. Should the consumer choose to move to another region, Liberty Resources will work with the CSPPPD contractor serving the region selected by the consumer and, depending upon availability of funding, will cover the cost of the consumers' specialized services at preestablished rates through the end of the fiscal year that the move to the new region is made.

    CSPPPD staff make every effort to secure services from local, state and federal sources. Liberty Resources successfully works with the OVR district offices in Philadelphia, Allentown and Scranton/Wilkes-Barre. Service coordinators have successfully secured services through UCP affiliates, community mental health/mental retardation agencies, the Multiple Sclerosis Society, Medicaid and Medicare.

TRAINING/EDUCATIONAL ACTIVITIES

    The unifying principles around which all CSPPPD training is designed are the stated program goals:

    All staff, consultants, advisors and subcontractors will be trained to empower consumers to:

All training will be evaluated against the goals listed above.

Objective 6.

    To establish and manage Clustered Shared Living Arrangements

    Liberty Resources will develop Clustered Shared Living Arrangements (CSLA) for consumers. The CSLA is any configuration of three consumers living in close enough proximity to pool on call personal assistance services to complement individual personal assistance schedules.

About the Author

Bonnie O'Day is a Research Associate at the NRH-Research Center. She is also a member of the National Council on Disability, appointed by President Clinton and approved by the Senate to advise Congress and the President on disability policy.

Bonnie holds a Ph.D. from the Heller School for Social Welfare Policy at Brandeis University and has directed centers for independent living in Massachusetts, Virginia and Minnesota. She has been an advocate for civil rights of disabled people since 1973 and has served on the boards of directors of national, state and local advocacy organizations.

About ILRU

The Independent Living Research Utilization (ILRU) Program was established in 1977 to serve as a national center for information, training, research, and technical assistance for independent living. In the mid-1980's, it began conducting management training programs for executive directors and middle managers of independent living centers in the U.S. Since 1985, it has operated the ILRU Research and Training Center on Independent Living at TIRR, through which is conducted a comprehensive and coordinated set of research, training, and technical assistance projects focusing on leading issues facing the independent living field. In January 1994, ILRU formed a partnership with the National Council on Independent Living to operate the IL Network, a national training and technical assistance project.

ILRU has developed an extensive set of resource materials on various aspects of independent living, including a comprehensive directory of centers providing independent living services in the U.S. and Canada. For more information contact ILRU; 2323 S. Shepherd, Suite 1000; Houston, Texas 77019; (713) 520-0232 (V), 520-5136 (TTY), 520-5785 (fax), e-mail: ilru@ilru.org, and URL: www.ilru.org.

ILRU is a program of TIRR, a nationally recognized, free-standing rehabilitation facility for persons with physical disabilities. TIRR is part of TIRR Systems, a not-for-profit corporation dedicated to providing a continuum of services to individuals with disabilities. Since 1959, TIRR has provided patient care, education, and research to promote the integration of people with physical and cognitive disabilities into all aspects of community living.

ISSUES IN INDEPENDENT LIVING
A publication of the
ILRU Research & Training Center on Independent Living at TIRR

©1999 by
ILRU Program
2323 S. Shepherd, Suite 1000
Houston, TX 77019
713.520.0232, 520.5136 (TTY)

ILRU PUBLICATION TEAM: Carri George, Rose Shepard, and Dawn Heinsohn.

Substantial support for development of this publication was provided by the National Institute on Disability and Rehabilitation Research and Rehabilitation Services Administration, U.S. Department of Education. The content is the responsibility of ILRU, and no official endorsement of the Department of Education should be inferred.