On January 29, 2010, the California Department of Developmental Services ( DDS) announced its intention to close Lanterman Developmental Center (LDC), located in Pomona, California. Briefing Report HS-01-10 (published on 5/12/10), entitled The Proposed Closure of Lanterman Developmental Center, provided some key background information on LCD as well as initial feedback on the closure plan from the Legislative Analyst's Office. (Last year's report can be read here.)
DDS released its most recent progress report in May 2011. Just how far has the closure progressed since it was announced nearly a year and half ago? Let us review what the report has to say.
According to the update, following an extensive planning and communication process with stakeholders, DDS submitted the proposed closure plan (Plan) to the Legislature on April 1, 2010. The Plan was subsequently approved in October 2010 through enactment of the Budget Act of 2010 and trailer bill provisions necessary for the success of the Plan.
The core principle of the Plan is to achieve a safe and successful transition of individuals with developmental disabilities from LDC to other appropriate living arrangements as determined through the individualized planning process and formalized in the Individual Program Plan (IPP). Consistent with the Lanterman Developmental Disabilities Services Act (Lanterman Act) and to ensure the health and safety of each person, transition will only occur after the necessary services and supports identified in the IPP are available in another appropriate setting. Closure activities will focus on identifying or developing community resources to meet the specific needs of the LDC residents.
The closure process will be informed by policies and initiatives that were successful during the closure of Agnews Developmental Center (Agnews), but will be tailored for LDC. Throughout closure, DDS will be continually communicating and working with stakeholders to achieve a smooth and successful closure. Closure will not occur until appropriate services are available and the last resident has moved to the living option appropriate for his or her needs.
The Plan is supplemented by important legislation that was included in the trailer bill to the Budget Act of 2010 (SB 853, Chapter 717, Statutes of 2010, Committee on Budget), as follows:
Statutes authorizing the extension of Adult Residential Facilities for Persons with Special Health Care Needs (ARFPSHN) to persons who are transitioning from LDC. These facilities are designed to fill a gap in the continuum of licensed facilities, specifically to serve individuals with stable but enduring special health care needs.
Statutes that provide for improved health care through managed care health plans for persons transitioning from LDC to the community.
Statutes authorizing the implementation of an Outpatient Clinic to provide health and dental services to persons transitioning from LDC, ensuring the continuity of medical care and services as individuals transfer to new health care providers.
Statutes authorizing the use of staff working at LDC to provide services in the community to former residents of LDC.
Additionally, in March 2011, the Health Omnibus trailer bill was enacted (AB 97, Chapter 3, Statutes of 2011, Committee on Budget) which amended the statutes implementing managed care to clarify the participating health plans. All health plans operating in the various central and southern California counties affected by the closure are included, thereby increasing the choices available to consumers for health care.
Number of Residents Transitioned Into the Community
As of January 1, 2010, there were 401 residents who are covered by the Plan. Of the 401, 398 were being served at LDC, with another 3 individuals temporarily receiving services from nursing facilities in the community. As of April 1, 2011, 337 residents are being served at LDC, and 51 have transitioned from LDC to community living arrangements.
Community Living Arrangements
Of the 51 consumers transitioned to the community, 41 moved to Adult Residential Facilities, licensed by the Department of Social Services (DSS); 3 moved into a Residential Care Facility for the Elderly, licensed by DSS; 2 individuals are being served in a Congregate Living Health Facility, licensed by the California Department of Public Health (CDPH); 1 individual is being served in an Intermediate Care Facility (ICF), licensed by CDPH; 1 individual moved into an ARFPSHN, licensed by DSS; 2 individuals are living in their own homes and being served by Regional Center (RC)-vendored Supported Living Services providers; and 1 moved to his/her family's home.
Identification of and decisions about all community living arrangements and services are individually based and reflected in each consumer's IPP. The individualized assessment and planning process is used to identify the individual's needs, preferences and choices, and the resulting services and providers. In addition to the community living arrangements listed above, core services that are considered for each individual include day programs and related transportation services; however, the transition assessment and planning process assures that individuals transitioning to the community receive the full range of services that they need to live successfully in the community and to assure their health and welfare, and may include specialized or supplemental services as determined appropriate by the planning team.
Demographics of Former Residents
Similar to the overall population at LDC, the majority of the 51 consumers living in the community were at LDC for many years. 59 percent lived at LDC for more than 30 years. The breakdown on the length of residency for the remaining individuals shows 17 percent lived at LDC for 21 to 30 years, another 14 percent for 11 to 20 years, and 10 percent for 5 to 10 years. Of these 51 consumers, none had lived at LDC for fewer than 5 years.
82 percent of the individuals transitioned into the community are over age 40. 12 percent of this group is 65 years of age or older, and 70 percent is 41 to 64 years of age. 16 percent is 22 to 40 years of age, and there was one resident (2 percent) under age 22.
72 percent of the consumers who were placed in the community have profound mental retardation and 16 percent have severe mental retardation. 10 percent of the individuals have moderate levels of mental retardation and the remaining 2 percent are persons who have been assessed with mild levels of mental retardation.
A majority of consumers have additional disabilities including 51 percent of the population with epilepsy, 4 percent with autism, and 2 percent with cerebral palsy. In addition, 39 percent have a dual diagnosis of both a developmental disability and a mental illness, 73 percent of the consumers have challenges with ambulation, 35 percent have vision difficulties, and 10 percent have a hearing impairment.
Former LDC residents require a variety of services and supports. Of the 51 individuals placed in the community, 39 percent need Significant Behavioral Support, 29 percent need Protection and Safety, 22 percent require Extensive Personal Care, and 10 percent have Significant Health Needs. None of the individuals were identified to be in need of a Low Structured Setting.
LDC Outpatient Clinic
The 2010-11 Budget trailer bill authorized the operation of an Outpatient Clinic at LDC. Like the Outpatient Clinic at Agnews, available health and dental services will be provided to individuals who move from Lanterman into the community, ensuring the continuity of medical care and services as individuals transfer to new health care providers. The statute requires DDS to operate the Outpatient Clinic until the Department is no longer responsible for the property.
An Outpatient Clinic does not exist at LDC today. The LDC management team is reviewing applicable regulations, building codes and licensing requirements, as well as requirements for vendorization by RCs, to establish the clinic. Additionally, they are working with staff familiar with the Outpatient Clinic at Agnews to learn from their experience and adapt appropriate policies and procedures for Lanterman's use. A physical plant assessment is being conducted to identify any potential modifications and equipment that will be needed in the prospective location for the clinic. LDC will be working with CDPH to augment its current license for providing outpatient services, and to address any other licensing issues that may be identified. At the Department level, coordination is occurring between DDS and the Department of Health Care Services (DHCS) to determine and plan for Medicare certification requirements, and identify any potential need for a State Plan Amendment. Along with defining the scope of services, DDS staff will be ensuring that appropriate utilization data are collected during operation of the clinic, and that a billing system is implemented for reimbursement for the services provided.
DDS is committed to the establishment and implementation of employee supports that promote workforce stability and provide opportunities for employees to determine their future. The Department has already conducted several employee forums for staff to provide input for consideration in the planning process. DDS management continues to meet regularly with employees at Lanterman to share information, hear employee issues and respond to questions.
It is the intent of DDS to help mitigate the impact on employees of the closure of LDC. In support of this commitment, employees will be:
Kept up-to-date with accurate information to assist them in understanding their choices and rights before making decisions that could impact their futures.
Encouraged to seek new opportunities to serve individuals with developmental disabilities within the developmental center or community service system.
Offered assistance to help develop personal plans that support their objectives and maximize their expertise.
Provided with opportunities to enhance their job skills.
As of April 1, 2011, there were 1,111 employees at LDC. Of these employees, 92 percent are full-time, 4 percent are part-time, and the remaining 4 percent are intermittent, temporary, or limited-term.
More than half of the employees (59 percent) have worked at LDC for 10 years or less. 25 percent of the employees have worked at the facility between 11 and 20 years. The remaining 16 percent have worked at LDC for 20 years or more.
66 percent of the Lanterman workforce is female. Of the total workforce, 45 percent of employees are 50 years of age or older and 25 percent of employees are between 43 and 50 years of age.
During the period of January 1, 2010, to April 1, 2011, 185 employees separated from employment at LDC.
The 2010-11 Budget trailer bill also authorized DDS employees working at LDC to work in the community with former residents while remaining state employees for up to two years following the transfer of the last resident from LDC, unless a later enacted statute deletes or extends this provision. This program is referred to as the State Staff in the Community Program. Much like the program for Agnews closure, LDC employees will, through contract, be able to directly support former LDC residents in their new homes, and thereby enhance the quality and promote continuity of services in the community. DDS is working with the Department of Personnel Administration to establish agreements with the appropriate bargaining units to support the program. Also, a marketing plan is being developed to provide information, generate interest, and obtain feedback from LDC employees, as well as RCs and service providers who may seek to contract with LDC to participate in the program. This initial information will help define the next steps and timing for program implementation.
The May 2011 report contains an updated timeline. What is important to note is that the transition of residents is listed as “Ongoing” on the timeline and does not have an estimated completion date. Additionally, the official LDC closure date is listed as “After all residents have moved,” and the status is “To be determined.”
Members of the Legislature have already made several decisions impacting the proposed LDC closure, and will likely have to make several more over the next year or so. As members weigh any option related to the closure, they may wish to consider whether it advances an expeditious closure of LDC while also ensuring that the needs of residents are protected.
Source: Update on the Plan for the Closure of Lanterman Developmental Center, DDS, May 2011
For more information on this report or other Human Services issues , contact Joe Parra, Senate Republican Office of Policy at 916/651-1501.