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Report: Nebraska on path to failure in Beatrice

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By NANCY HICKS / Lincoln Journal Star

Tuesday, Dec 16, 2008 - 08:02:09 pm CST

It will take new leaders at the top, a new culture or attitude among employees in Beatrice, and more options and better oversight in community-based programs before the state can fix the problems at the Beatrice State Developmental Center, according to a legislative report.  

And just in case the state-run institution doesn’t pass federal muster, the Legislature should set aside the $28.6 million to replace  lost federal Medicaid funds, according to the report released Monday from a special committee investigating BSDC issues.

But with the right changes, the state institution could become a center of excellence for the residents and for community-based providers, according to the report.

Story Photo
In this May 20, 2008, file photo, resident John Nichols (right) speaks with State Senators Abbie Cornett (left) and Steve Lathrop as the senators tour the Beatrice State Developmental Center. (LJS File)

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To read the report



Go to the Legislature's Web site at NebraskaLegislature.gov and click on "Report on LR283" in the center of the page.


Beatrice clients



Beatrice State Developmental Center has the most challenging clients. Some statistics:


  • While 50 percent of the community-based clients are mildly disabled, only 16 percent of BSDC clientele are mildly disabled.
  • Only 6.4 percent of people in community programs have profound disabilities (the highest category), while at BSDC they represent 59 percent of the population.
  • 52 percent of clients at BSDC require a wheelchair; 10 percent in community.
  • Clients with uncontrolled or difficult-to-control seizure disorder: 39 percent at BSDC; 12 percent in community.
  • Clients with severe mental illness: 66 percent at BSDC; 46.3 percent in community.




Recommendations



At Beatrice State Developmental Center:


  • Commit to keep BSDC open, available for people whose needs cannot be met with community placement.
  • Create a study group to look at the viability of having a private company operate the center.
  • Continue special BSDC legislative committee to oversee that recommendations are implemented.


For community programs:


Like BSDC, there are also staffing shortages and lack of properly trained staff for community programs. Some recommendations:


  • Create regulations for better oversight of community-based programs.
  • Increase state staffing so there are enough inspectors to inspect community-based programs more than once every four or five years.
  • Increase community-based capacity.
  • Review funding formula so reimbursement covers cost of high-need clients.
  • End waiting list in four years. No cost for this was listed, but another report released last week indicated the state would have to spend an additional $11.5 million each year to end the waiting list in seven years.

Specifically, the legislative committee said it had no confidence in three leaders: Chris Peterson, Health and Human Services Department CEO; John Wyvill, Division of Developmental Disabilities director; and Ron Stegemann, CEO at the Beatrice institution.

The leaders have demonstrated a “mentality of ‘what do we have to do to get CMS ( Centers for Medicare and Medicaid Services) off our backs’ rather than vision and leadership,” the report said.

Peterson said her announced retirement last week to spend more time with her family has nothing to do with this report.  And Wyvill  said he has no plans to leave.  

The committee’s no confidence statement “does hurt, but it comes with the territory,” Wyvill said in a telephone interview Monday afternoon.

“My job is to stay focused and implement the plans we have at BSDC,” he said.

The entire senior staff has been replaced since September 2006 when the first of nine federal inspections took place, he pointed out.  

The management has also been able to reduce overtime by 25 percent and the much criticized mandatory overtime by 95 percent, Wyvill said.

The special legislative committee was appointed last spring to look into problems at BSDC.

Nationally recognized for its quality in the 1990s, the institution is in jeopardy of losing federal Medicaid funds that pay for more than half the $50 million annual costs.   

It is also under Department of Justice scrutiny, with an independent expert hired to follow the state’s efforts and report to a judge.  

HHS will not win its appeal on the Medicaid funding, and instead is working toward getting BSDC recertified by Medicaid next spring, according to Sen. Steve Lathrop, of Omaha, chairman of the committee.

However getting recertified will be very difficult, because the federal inspectors “will be looking for perfection” and the remaining clients at BSDC will be the most difficult to care for, said Lathrop.

The state has already fallen short of its goal to get BSDC “right-sized” to 200 clients by Jan. 1, one of the potential prerequisites for recertification, he noted.

There are about 250 people living at the state-run institution, about 50 less than one year ago.   

But Peterson and Wyvill said they still hope to move 50 more people into community programs before the spring so BSDC will  have enough staff to meet federal requirements.  

Currently, there are 92 individuals at BSDC who could easily move to community programs except for guardian opposition to moving, said Wyvill.

Many guardians do not believe that communities have the kind of programs their family members need, according to the report.  

And the state has not provided sufficient incentives so that community agencies can develop homes and programs for these BSDC clients, according to a Department of Justice report quoted in the committee report.

Gov. Dave Heineman and the two HHS leaders said they agreed with much in the committee report, including changing BSDC employee attitudes and culture, greater oversight of programs in the community and increased funding for agencies that offer the community programs.

Though many of the recommendations will require spending more money, the report does not specify how much money will be needed.

The only dollar amount is the $28.6 million the state will lose if the Beatrice institution is not recertified by Medicaid.

In a letter to the committee Monday, Heineman said his budget proposal will provide funding for the possibility that BSDC fails to be recertified.

Heineman also said he will seek money for additional inspectors so that community-based programs will be inspected more than once every four or five years, as is now the case.

Lathrop said the state will have to spend more money for adequate  services  or pay to fight lawsuits.

Reach Nancy Hicks at 473-7250 or nhicks@journalstar.com.

.


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This is not just Beatrice wrote on December 15, 2008 11:09 am:
" The failure of the BSDC is not about the failure of government oversight. It is about failing to deliver to those in the care of BSDC. We are talking about lives, not a brick and mortar building. As a society, we need to be committed to serving those in need. "
Didi wrote on December 15, 2008 11:16 am:
" It's no surprise the state is on a path to failure. Gov. Heineman has had it out for mental health services since he took office. He pushed for closure of other regional centers, has reduced reimbursement to mental health providers, and now, the latest, he wants to limit the number of outpatient visits Medicaid recipients can get. So much for mental health parity in Nebraska! "
DR wrote on December 15, 2008 11:32 am:
" Go Governor Heineman! Pretending that many patients can be mainstreamed into a productive society is an expensive theory. Some taxpayers a better grounded in reality and Governor Heienemann is representing us. Are we the majority? ONe person right can be a majority. Go Governor Heineman! "
Frustrated wrote on December 15, 2008 11:37 am:
" This is part of Mike Johanns' legacy as Governor, but Heineman never seems to miss an opportunity to attack those who are unable to fight back. "
Hmm wrote on December 15, 2008 1:47 pm:
" Interesting that the CEO announced her retirement last week "
BicycleMike wrote on December 15, 2008 1:49 pm:
" Governor after Governor have been made aware of the issue at Beatrice and they continued to brush it aside. Now the blame games have started. Where does the buck stop again?? "
J wrote on December 15, 2008 2:02 pm:
" This makes me so sad. We're talking about real people. God bless the residents and those who care for them. "
if wrote on December 15, 2008 2:35 pm:
" CMS will re-survey in the next year, this isn't the time to be replacing administration at the facility with people who have no clue..... "
Mark wrote on December 15, 2008 2:36 pm:
" "What's-the-least-we-can-do-to-get-by" seems to be the philosophy of the Community-based programs as well. There needs to be a culture change at DHHS in its Developmental Disabilities Division. Service delivery is at times lacking and some of the DDD officials seem to care more about protecting themselves more than protecting those they're supposed to serve. "
timmy wrote on December 15, 2008 3:47 pm:
" Privatizing this is not the solution. We'll get no "votes" on the matter if a corporation is running the center, and transparency will likely be even more difficult. The central problem, as stated in the report, is grossly inadequate funding and oversight. Since this is a LONG ongoing problem that Governor Heineman was made painfully aware of in 2006 when a federal investigation found three instances of “immediate jeopardy” at the center, and yet the center then failed an astonishing three more federal inspections in the next one-and-one-half years, it seems clear that the buck must stop at Gov. Heineman's desk. In March, 2008, the LJS reported, 'When HHS was reorganized last year, one of the rationales for doing it was for accountability — not only within the agency but directly to the governor, said Sen. Phil Erdman of Bayard, a member of the Legislature’s Health and Human Services Committee.' He asked for the accountability and now he’s going to get it,' Erdman said. If that is the case, then exactly where is Governor Heineman? Where is the accountability? If he cannot adequately oversee one of the most acute needs in the state, one where the already finacially hobbled state stands to lose over $28 million in federal funds, no less, just what is Mr. Heieman getting paid for? This is tragic and shameful. What more fundamental thing do we ask of government than to help and protect those in our society who, truly, cannot help themselves? If our elected leaders cannot, after repeated warnings, accomplish such a fundamental task, then it is really time to send them packing. "
Suggestion wrote on December 15, 2008 4:08 pm:
" Perhaps if the state could negoiate mid-management salaries and really compete for top talent they could make progress. Direction for change I have, but I couldn't afford the paycut to work in state government. "
watching from front row wrote on December 15, 2008 5:00 pm:
" As one who has knowledge of the States responsibility, the state officials in charge of monitoring instances of abuse and neglect have infact let the patients, employees, BSDC and state government down. The state employee responsiblility is to see that changes are put in place and that these changes are indeed being made at the facility. Where were the people who have been working on this Problem for the past 2 years. How many ON-Site hours have the state surveyors logged there on a weekly or even a monthly basis in the past year? What is the behavorial health supervisor for the state surveyor doing? Who is reviewing the suggested changes at the state? Why has this not been monitored on the state level with a state employee at the facility on a daily basis?

There is much blame to cast on this unfortunate, nationally publicized failure. But like always the ---State of Nebraska--- will cast blame, never say sorry, shove these patients out into the community into a lower level of care with less state monitoring of their care.

All of this on top of lets cut the amount of mental health and substance abuse treatment offered my Medicare. Nice. Very Nice. Feels great to live in this state. Maybe we should switch to a democratic state...you have not heard of this happening in our neighboring states. "
State Officials are problem wrote on December 15, 2008 7:03 pm:
" This problem brewing for the past ten years finally couldnt be ignored anymore. the top state officials at HHS and our ex govenor johanns should be brought up on adult abuse charges themselves!! They are the ones who let this go on for so long. They are the ones appointing those ninnies who agree to do the job and not make waves. No wonder the new appointee quit, she couldnt sit on her hands and collect a paycheck like the others.
the foster care system is next Nebraskans. "
whatever wrote on December 15, 2008 8:58 pm:
" Instead of "setting aside" money "just in case" how 'bout appropriating an additional 30 million for a couple of years and develop the institution to it's fullest. At that point you should be able to reduce some of the costs if necessary. "Setting aside" is the same as spending and it's an absolute defeatest attitude. Also keep in mind that it's very likely an investment of an additional 30 million will be cheaper in the long run as you can take it to the bank that over the next 8 to 12 years Nebraska will likely be mandated to pay for it's reckless ways. "
Concerned wrote on December 16, 2008 5:59 am:
" If wrote ..."CMS will re-survey in the next year, this isn't the time to be replacing administration at the facility with people who have no clue....." Even a cursory reading of the actual report will tell you that it is the current administration which doesn't have a clue, so replacing the current administration with competent, motivated people will be a step forward. "
DJ wrote on December 16, 2008 9:53 am:
" Quick way to "fix this"...just apply for a Bailout. Everybody's doing it! Would be a lot easier than trying to "fix the problem". "
go community programs wrote on December 16, 2008 11:12 am:
" My question is for the family members/guardians of people in beatrice. How can you keep your family members there knowing all the horrible things that are happening? Community based programs are a better option for people with disabilities. They offer community inclusion and a feeling of self worth. If you loved your family members with disabilities you would look into getting them into a community based program. You wouldn't believe the difference they can make in a persons life. They can help them have a feeling of accomplishment, help them get jobs, reguardless of the extent of their disability, and give them a meaningful life. Beatrice should be ashamed of themselves for the way they treat their individuals. I pray for them every day! "
Two systems both good for some wrote on December 16, 2008 11:51 am:
" Go community programs???

Many have had their loved ones in community programs in the past and had many problems! They've "been there, done that" and know that BSDC is the best place for their loved one - don't tell them what to do until you've walked a mile in their shoes.

Just a week or so ago the Lincoln Police were commenting at a public meeting that the community programs were causing them problems as they didn't have enough trained staff to deal with difficult situations so when they have problems they just call the police to come deal with it.

One real telling thing was pointed out in the article - the community based programs are only checked every four or five years! This is true federally too - it's more cost efficient to audit a big facility than it is a low census count community program so they put the big facilities under the microscope and ignore the community based facilities. If they do find problems in a community based facility they just shut it down without much ruckus as it's such a small program it doesn't generate the large community wide concerns.

Community based isn't the answer, neither is centralized facilities. The answer is a mix of both, so lets stop this "it's got to be this way or that way" mentality and realize we need both and work to make both the best they can be - BSDC needs some money and leadership, community based needs that and as much oversight as the facilities have. Do those things and see what you have and roll up your sleeves to adjust and make them both work as well as possible!

" My question is for the family members/guardians of people in beatrice. How can you keep your family members there knowing all the horrible things that are happening? Community based programs are a better option for people with disabilities. They offer community inclusion and a feeling of self worth. If you loved your family members with disabilities you would look into getting them into a community based program. You wouldn't believe the difference they can make in a persons life. They can help them have a feeling of accomplishment, help them get jobs, reguardless of the extent of their disability, and give them a meaningful life. Beatrice should be ashamed of themselves for the way they treat their individuals. I pray for them every day! " "
Janine Stearns wrote on December 16, 2008 3:04 pm:
" Being a parent of a chld with a severe developmental disability I really believe that the drive by the CEO and management at the BSDC If only they themselves could put the humane back into the human they might be able to turn their ship around. It is a sham how society turns on people who can not care for themselves.If the people in charge can not be the voice of these people to be properly cared for then they should not be allowed to work in this capasity. Money going out to contracted workers and nothing to screen employees better and train them properly.Call me if you need a lesson in how wonderful people are with developemental disabilities. Wake up Govenor Heineman, spend a day with me and my daughter and perhaps you will come out of your cloud that developmental disabled people should be treated humanely, by competent staff. How do you people sleep at night, knowing you can pass the buck and never find a solution to the problem.Taking away the money is not the answer, Most americans who raise a child with developmental disabilites,struggle finacially as the person requires more health care,more co-pays, parent misses more work,Imagine a person growing into a adult who is never able to get out of diapers,needs several medications,Some can't walk The people who reside at the BSDC are unable to care for themselves and the parents are unable to care for them they are left with the only option to place them their. How on earth can you turn your back on these people, Society demands good daycare providers,to care for their children, they demand their parent have elder rights so they are free from abuse.How would you feel if this were your brother, sister, child. I know I am tired of the excuses, How about changing the attitude, that every person matters, regardless.... You need help, I am always up for the challange, I would be glad to spearhead your training department, The attitude starts at the top so let me know when your ready to make a difference, These people depend on a strong voice of a leader who knows what the standard of care should be. "
Former employee wrote on December 16, 2008 5:04 pm:
" There are way too many husband and wife , sister-inlaw, brother-inlaw teams/good ole boy networks going on to make any changes there. It didn't help when the free health insurance went away for the state employees and there spouses too, everyone has to suffer on that one with the bad attitudes. "
Lincoln Taxpayer wrote on December 16, 2008 8:19 pm:
" Hmm...didn't Mike Johanns fix this when he was governor? Thanks again for another job well done and completed (said with tongue firmly planted in cheek). "
Shameful wrote on December 17, 2008 12:09 am:
" The State is so far behind the times in supporting BSDC financially or with proper staff. The "One Flew Over the Cuckoo's Nest" mentality in providing care to this population has been ongoing for years. If my loved one was there today, they sure wouldn't be there tomorrow. Close this place down please! "
Former Employee wrote on December 17, 2008 5:00 am:
" The talent pool to hire from is waaaay too shallow there.

Everyone knows everyone, and to some extent will "look out" for each other.

New hires are either kept in the dark, given jobs away from the other workers, or somehow given the message that things are going to be done a certain way or else it is their word against yours.

The only chance would be more supervision. And to make sure they had the guts to call out employees. I had seen them turn away at the first hint of a something bad.

Move BSDC to a bigger population. Lincoln is too far away and when gas prices start going up it will seem like it is 100 miles away. Move it to near lincoln or Omaha. Maybe Grand Island.

Basically on top of moving it to a larger population, you will have to dump everyone that works there. Of course not everyone that works there is bad, but everyone shares the "Us vs. them" mentallity as far as an employee's view of any kind of management/regulations. This mentallity in ANY form is just going to undermine all efforts on all levels. "
feds refusing to fund NE wrote on December 17, 2008 8:56 am:
" We've heard of high dollar coffee pots, over paid staff and so forth from our federal government. But, the analyses of the past several years of BSDC by many government and private organizations is that it is so badly managed and funded, that our own federal government has threatened to pull out of it, taking it's $29 million a year away. Why shouldn't they? We expect results in our country don't we? We expect quality schools, hospitals, national parks, legal systems, etc. But the gov't in Nebraska has not stepped up to meet even the minimum standards of the federal requirements. We continue to elect good-old-boys, and expect them to know how to manage...Heineman doesn't have what it takes. He has apparently failed, again, to manage a system which affects many hundreds of citizens who cannot take care of themselves. If another country locked similar people into a facility that fell far below national standards, wouldn't we wonder, is this a third world country, what's wrong with it's leadership, why aren't people demanding something better?...here, we accept it, apparently. In Nebraska, it's ok to treat people with disabilities badly--in fact, that appears to be the Governor's policy..as long as it can save a buck, and keep a "conservative" voter donating to his re-election campaigns. "
concerned citizen wrote on December 17, 2008 9:48 am:
" I agree that what is happening with the Beatrice home is terrible, and I wish there was a good answer and out come for it, However, I would like to add the question of is things that are happening to Nebraska in the best interest of its citizens. Please in your search for answers to your guestions, look also at the outcome that Call Centers may have on the hardship of are citizens to get their needs met from the State.
Is this the best answer for US as citizens or the Politicians looking to make the budgets look good? "
sister wrote on December 17, 2008 10:04 am:
" All these comments and how many people actually deal with Beatrice. If regional centers would not have been closed down to help the people with mental illness Beatrice probably wouldn't be having these problems. My brother has been there 30 years. He is severly mentally handicapped with constant seizures. He has been in community placement but they couldnt handle the seizures and the other problems seizures can cause. Dont tell us what to do with our family members until you have been there. Every situation in Beatrice has a unique story and they all need to be listened to. Not all the information is covered in a news reporter articles they are just doing there job. It is tough hearing all of these horrible stories but don't condemn us for having family members at Beatrice until you know our unique story. All humans deserve the help they need whether it is mental illness or mentally and physically handicapped but it all comes down to money, staff and the administration. Everyone that I have ever met at Beatrice deserves a big thank you for the work they do. Think about how you will handle putting your parents in a nursing home and them having to live there for 5 years or more. Things happen there so is that any different then Beatrice? "
Informed wrote on December 26, 2008 5:55 pm:
" More evidence of the official attitude toward serving the public interests - especially those who are the most vulnerable. Gov Heineman, especially, does not care. The Legislature is either naive or uniformed. Official Nebraska thinks these people, as well as those in the behavioral health division, are expendable. Unworthy. The only ideas for "reform" are rehashes of the same old, same old: shore up the crisis system. We drive people to the extremes of illness, behavior before the system responds - and then - it is in archaic, stereotypied, fear-driven, and discredited practices, procedures.

We do not need a new jail. We need modern, recovery based mental illness servces provided by people who are up to date and skilled in recovery, trauma-informed culture, environments, strategies, etc. Contrary to the predicatable protests from academia, there is no training in Nebraska of social workers, doctors, nurses, teachers, etc in these proven methods. A literature, with a new syllabus and a lecture does not transform the culture, attitudes or consumer results from being a part of the system.

It is way past time. Where are your professional standards and practices? How can BSDC & mental health services keep going like this without effective challenge? Hippocratic oath? Licensing & credentialing? So everything is being done as legislated, but it's NOT WORKING? It has to change.

The entire lot has to be cleaned out. Take HHS out of the Governor's office. All he & his minions care about it keeping their place in high paying jobs, building the "surplus". False economy to say the least. Then, clean house: Scot Adams on down. Bring in staff who have proven records of system reform, recovery practices, culture change, education that transforms, and follows the federal & state guidelines/fundamentals of recovery in planning, evaluations, budgeting, etc. This includes meaningful participation by consumers and family members. Listen to those who have been in a regional center, or jail. If what certain senators really want is economic development [keep the regional centers], then they see the merit of massive re-training of LRC/HRC/NRC staff, staff dismissals and skilled new hires throughout the system for achieving recovery results, not dressed up institutionalization, control, compliance, and dependency. Shape up services from the first contact. A lifelong system is too expensive in every way - not just dollars. Recovery-focus must be adopted for real. The current fear-driven, outdated practices is unsustainable financially. Not to mention the wholesale violation of human rights, civil rights.

HHS only works to parse words to sound right, cover it's tail, give the right appearance. There is no leadership, innovation, or even interest in doing the 21st century, humane services at the top. Take it out of direct political influence & put it in the hands of credible, skilled, knowledgeable people hired on merit, rather than being "pro-life" Republican, family values flag wavers. What hypocrits. "
Cathy wrote on February 5, 2009 9:43 am:
" People with disabilities can and should be able to live and flourish in the communities of their choice. And, for those of you who think that it is more expensive, you are wrong. It is much more expensive to provide institutional care to people with disabilities and their quality of life (let's not forget that!) is lessened immensely. Communities and politicians have to be willing to do their home work, listen to providers and communities and make decisions that are in the best interest of the people. "

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