November 14, 2013 (Rescheduled for November 15, 2013) - Quality Care Board Meeting

Helping Families. Supporting Communities. Empowering Individuals.

Audience

Open to the Public

Date

Friday, November 15, 2013

Time

10:00 am - 12:00 pm

Location

Via teleconference

Phone #: 888-494-4032 Access Code: 1469835118

Present: Susan Keegan, Chairperson; Ginny Conlee; Thane Dykstra; Untress Quinn; Neil Posner; Inspector General Michael McCotter; Deputy Inspector General Robert Furniss; and Chris Milbrandt

Meeting Minutes

1. Reorganization Update

 Deputy Inspector General (DIG) Furniss stated legislation was enacted that transferred the responsibility of conducting investigations of abuse and neglect involving people living at home to the Adult Protective Services (APS) Bureau. The five investigators involved in that had to be transferred over to handling Rule 50 investigations which include abuse, neglect, and financial exploitation investigations at DHS-funded facilities, CILAs and day-training sites. As a part of that, we had to absorb these staff and absorb them in place. We reconfigured the OIG bureaus, the most significant portion being what was formerly our Metro Bureau, which included Cook County and collar counties. This area was divided into two separate bureaus. The objective of all of this was to deploy these investigators in place. We couldn't move them to different counties or cities due to union rules. The objective was to reconfigure this based on the number of cases we were receiving per county. We were trying to bring down the number of cases to 90 - 100 cases per year. We are now in the process of evaluating this because we have encountered a few problems with our initial estimate of what was going to be happening.

 The former Metro Bureau, which is now Cook Bureau (Cook and collar counties) came into this process with quite a large backlog of cases. They were down an investigator. The new Metro Bureau absorbed two of the investigators from Rule 51 so they have had relatively little experience doing these other cases. It has taken longer to get them up to speed. The other thing we had not anticipated is there are two counties we had shifted from Central to South - Madden and LaSalle counties. For some reason, it could be because of the impending closure of Murray MHC, but we have had an explosion of cases in that area. At the next bureau meeting we will determine if we need to reconfigure the bureaus or give some of the territory back.

 The other assumption we made is that we thought we would have a full investigative compliment in place when we started to do this. As it turns out, we have filled two of the investigative positions. We just filled one of these positions and will fill another one next week. They will not be fully functioning investigators until at least the new year. One of the new hires is replacing an investigator that just didn't work out. We have another opening in the Central Bureau that has been open for seven months. These positions are all subject to union bidding rules. We only had one select bidder and the person selected did not want the job so we had to start all over again.

 One of the problems we have had in filling these positions, despite the specific fact that we require two years of investigative experience, is when people with contract bidding rights put in for these positions, CMS determines what grade they would be given in this competitive bidding process. We are finding that CMS, in at least four cases, have been giving an "A" grade to people with no investigative experience at all. We are not getting the people that we would like. In one case we had an opening in Choate MHC and the investigator we had at Chester MHC, with four or five years of experience, was one of the bidders for the position and was rated third on the list behind people with no investigative experience.

 Question: Can we talk to CMS? DIG Furniss stated that he is going to talk to CMS. We know it will take a lot of time to tighten up the job requirements in these bid packages.

 What we are faced with in these situations is that if we determine that we don't want any of the people that they give us, then it starts all over again or it goes to the open competitive bidding and we don't have any guarantee that the people on that list are any better. An example is the former occupant in the position at Central left in January. We probably won't have anyone in there up and running in over a year. These are factors that have made it more difficult.

 We have balanced the cases in two bureaus, four investigators who have 75 cases a piece. The people helping them out have a caseload of over 45 cases a piece. If you take people that manage their backlog to a minimum and turn cases out, their reward is they get more work to do. We have to be very careful of not presenting a negative incentive. IG McCotter has been determined to increase our headcount. I have been here eight years and our caseload has gone up every year. Our caseload has increased 75%. During that same period of time, we have gone from 28 full-time investigators to 24.

 Question: Do you have a process where you prioritize cases by the most pressing or most precarious? Yes. Cases in which employees have been put on administrative leave (AL) because both of the divisions have a policy in the facilities that if someone has an allegation placed against them, they have to be either placed on AL or taken out of the count, no matter how trivial the case might seem. They do this because a number of years ago the Department of Justice came down on a couple of facilities because people had substantiated physical abuse charges against them and they were still working with clients in the interim.

 We also had an informal process we had to abandon for the same reason where if our investigator began looking into something and determined early on that there wasn't anything to it, that we could tell the administrator this is a case of physical abuse, there are no witnesses to this, it seems impossible that this could have happened, we wanted to let you know so you wouldn't have to keep this person out of the count.

 The other problem we have is some of the bureaus are relying on agency investigators to do this. The quality of the investigations we get from the agencies are pretty spotty. Some of the investigators are very good, very efficient. We have other agencies and situations where some of the cases can drag on for months.

 Barring getting more people in addition to the headcount we currently have and getting all of the positions filled by the end of the year, the backlogs are not going to come down significantly until that time. We are going to have to triage these cases and try to get them out as quickly as we can. This will lead to other problems. You want to make sure you are still doing a thorough job as the cases continue to come in. Whenever we have an impending closure of a facility, the cases mushroom both because when people are placed out of a facility there are allegations made that the receiving institutions are not prepared for the influx of individuals. The parents of the people who are in the facility are not happy about the fact of the closing and then staff who are on the verge of losing their jobs are calling in allegations. It is happening at Murray right now.

 The last time we were audited, the average caseload was 44 days, the best it has ever been. We told the auditors at that time that we didn't think we could do better than this ever again. We were still cited for timeliness. We asked them when we can have that finding removed. At what point is that going to be good enough? Since that time, we have had more vacancies than we have ever had, and more cases. Also, under the old structure, we had two office associates who were doing administrative and clerical work, but we did not have anyone in those positions for the Metro, Cook and Northern Bureaus (the busiest bureaus) for a period of five months. They now have one person doing the work that requires three people. We have just gotten approval for an emergency approval. Question: Is it a hiring or budgetary issue? A budgetary issue. We have faced a dwindling headcount for years. We always worried when someone would leave that they would cut a position.

Question: Do you have a summary of this that we could review? There is a lot more reporting because people are more aware of what they need to call in. The documents that Chris sent you reflect a big jump relating to domestic cases that we no longer have. Stems from the negative publicity we got a little over a year ago. DHS decided to publish our hotline number in big numbers on the website and we had an explosion of calls for the next nine or ten months. This year we are looking at a substantiation rate in these cases, it is the lowest rate we have ever had. It is 10%. Question: But you still have to do the work? Yes. We don't want people to try to determine in their own minds if it is abuse/neglect or screen these calls. This last year has been the biggest jump since I have been here. Question: Do you have a written document that details what you have just said? IG McCotter stated that we did a review of all cases about a month ago. Due to the shortage of staff and explosion of reports, 43% of our cases are 60 days and older. At 2:30 p.m. today I am meeting with the Secretary regarding getting additional clerical staff, a clinical nurse, training leaders, and ten more investigators. Our headcount is 57. I am asking to increase this by 15. Secretary Saddler has been incredibly supportive of our efforts throughout the reorganization. We can't do any better. We have a tendency to keep working our better people. We have a technical person who handles our database. I am asking for an additional person for him as well.

Ginny stated that CMS is the key problem. Even if you get more headcount, you will never get ahead of the game. CMS is the issue here for you.

IG McCotter stated that there are some basic skills out there, we need to be able to grab them and we just aren't able to do it.

DIG Furniss stated we know of at least one investigator in our group that is going to retire and about four or five others that have periodically tested the waters in that area. I am anticipating in the next 1 1/2 years we may lose 1/5 of our staff. This is a very worrisome situation. We were able to get a retired investigator back on a 60-day contract. It was enormously helpful.

We have clinical coordinators who are registered nurses. One was a contract person, the contract was put out for bid, another person got the contract, the incumbent objected to it, they gave it to her, the person who got it the first time complained, so they threw the whole thing out and started over. In response to that, we have a clinical coordinator who retired and she came back on a 60-day and we will probably extend that and it has been extremely helpful. They are all on contract.

Question: Is this a personnel issue? Clearly there are people in our group who are not as productive as others. In a situation like this, if you are faced with a situation of having that person vacating that job, it could be six to eight months waiting for a person to fill the position.

IG McCotter stated that we need more personnel. If we don't get the personnel and deal with CMS and get people hired that can do the job, we are heading down the path we were on a year ago. Ginny stated that one of the better things that might happen to you is that the auditors do come in. IG McCotter stated that if we can get the right personnel in the right key spots there wouldn't be a problem. Ginny stated all I am looking at are ways to get people to put the pressure on to point out how unattainable the whole thing is. They can't keep beating you up and not do anything to fix the problem.

DIG Furniss stated that one of the other issues of the legislation that transferred the DAP over to APS is to set up a centralized hotline that would be for us, HFS, IDPH, and APS. It would be one number that everyone would call. We have some issues with that approach because initially it appeared that what they had in mind was a single hotline and we pointed out to them that our hotline people are investigators and it may take longer to develop an intake because they have to ask a lot of questions. Hopefully our hotline will continue to exist and operate in the state facilities and CILAs. The only thing a centralized hotline will do is, for example, if a person at a bowling alley sees people there at an outing and someone shoves a person and they call us from a central number. Most of them would be non-reportable. I can't see more than five to eight percent of our reportable cases coming from that. They were going to take the hotline function away from us. I told them not only do the hotline investigators evaluate these cases, but they also develop intakes and send them to the respective bureau chief. It is not a centralized hotline where all of the intakes will go to the central bureau chief, who is also trying to run an investigative unit. That bureau chief will be deluged with all of the intakes and will have to distribute them to the other bureau chiefs. The state of Texas has 370 full-time people on their hotline. I think they are talking about a fraction of that staff. It is essential that our hotline remain in place and act as the gateway for those calls that come from them and we continue to accept calls from DHS facilities and programs.

Question: Isn't there federal money for senior hotlines? I think here in Chicago they get money for hotlining. I am just wondering if we are missing out on some of that. We can always use more people. We think the hotline can hold its own because we are no longer taking domestic calls. That was close to 1500 cases that came in, not including non-reportables. Total is probably close to 2,000 calls that they are no longer getting. At one time the hotline was eight days behind. Question: Could we use more people? Absolutely. This is one area where this legislation has held us. IG McCotter stated that we are up to date and current. Our concern lies in the investigative and clerical areas.

Chairperson Keegan asked if we thought the Board should be writing anything to the Governor that we need more funding to do an adequate job? IG McCotter responded yes and that we may request to have more bodies. DIG Furniss stated the fallout from the article 1 1/2 years ago sparked a lot of legislation. We need the best people and resources to do our job. It is a much more difficult job now than it was ten years ago. The good news is that two investigators just started and we think they are going to be really good. One is a former facility investigator who won't need any training. The other person is a former DCFS investigator, who we don't think will require much training.

2.  Oversight of OIG

 Chairperson Keegan stated this has been covered. We just need to get the report. This is the kind of thing we need to be looking at to be effective. Trying to get some attention and help you with CMS and increasing your budget. I would like to take a crack at writing a letter if someone else on the Board would like to volunteer. Neil will help. Neil stated it may also be helpful with the perspective of knowing what the ask would be. I heard the plea of all of the issues. I am struggling to hear what the solution would look like. IG McCotter stated I have a draft report now. What I am asking for is two investigative team leaders - we have five bureaus and three investigative team leaders - they assist the bureau chiefs and handle a caseload on their own; an office associate in the northern bureau; one database support person; one clinical coordinator (nurse); and ten investigators.

 Chairperson Keegan asked why don't you send a letter to Neil and I and we will reiterate it? IG McCotter stated he will tweak and give it to the Secretary. He will then send it to you. Neil stated the Secretary is the decision maker, but she may have to reallocate funds in order to turn her agreement with you into reality. Who are the influencers? Who gives her the support so she can do that? IG McCotter responded this is the time when they increase headcount.

 DIG Furniss stated one of the other problems we are encountering on getting office support staff is that these positions are low paying. Few people apply for them. There is a title called office coordinator. It is a higher paying job, and more accurately reflects what these people are doing. It is much more entailed than your typical office associate position. Potentially the other four office associates could file a grievance and we could promote them as well. IG McCotter stated that once again CMS comes into play.

DIG Furniss stated a couple years ago we had an additional investigative team leader and database position. The ITL was on military leave for over a decade and never came back. When he retired, they eliminated that position. The database person retired and they eliminated that position. If you go back ten years, our headcount at that time was 64 or 65. What Mike is requesting exceeds that number, but not by much. In those days we had 27 investigators, we now have 24. IG McCotter stated if we can get staff hired and working, and allow for attrition, we can handle the two or three retirements we are expecting.

3. Approval of September 11, 2013's meeting minutes

 Motion to approve the minutes - Ginny

 Motion seconded - Untress

 All in favor - Minutes approved as written

4. Miscellaneous issues/questions

 Chairperson Keegan reminded IG McCotter to send them their report and they will get their letter out and it will help them on their oversight. IG McCotter stated they will be sent the same report he is giving to Secretary Saddler. Chairperson Keegan stated we have to have our own letter. We will run it past you to make sure we don't have any errors. IG McCotter stated we appreciate your support.

 Chairperson Keegan stated the next meeting is January 9th at 2:00 p.m. If that date is not a good date it would be good to know right away. Let's get the date firm. In the next week or so, confirm that you are going to be able to attend with Chris.

The Annual Report for FY13 is nearly complete. It's due by the first of the year. Chairperson Keegan asked that it be sent to them as soon as possible so they have a chance to review it.

 Next Quality Care Board meeting is January 9, 2014 at 2:00 p.m. by teleconference.

 Motion to adjourn the meeting by Neil. Motion seconded by Ginny. Meeting adjourned at 11:00 a.m.

- Next meeting is January 9, 2014 at 2:00 p.m.