Allegations of abuse, neglect and exploitation, as well as the number of critical incidents and deaths in the state Department of Disabilities and Special Needs system, all increased in the past fiscal year, records released Thursday show.
The DDSN Commission, in approving on Thursday its budget request for next year, attempted to address some of the increase by asking lawmakers for $900,000 for additional psychiatric and behavioral support services, including the possibility of telemedicine.
DDSN Commissioner Vicki Thompson said she believes behavioral issues are behind the increase in some critical incidents, including increases in aggression-related incidents and a nearly doubling of the number of attempted suicides.
Wednesday, she advocated the use of a psychiatrist and nurse practitioners in each region of the state to address behavioral health, but officials said psychiatrists are in short supply in the state and recommended developing telemedicine links statewide so psychiatrists can see more patients via video screens, a system used by the state Department of Mental Health.
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According to DDSN’s figures, the number of critical incidents, which include hospitalizations, assaults, police calls, thefts, medication errors, fires and attempted suicides, increased for the fiscal year ending in July from 1,953 to 2,206.
The figures include residential and day settings as well as the agency’s regional centers.
Abuse, neglect and exploitation allegations increased from 627 to 749, while deaths increased from 89 to 102, the figures show. All deaths are investigated by the state.
The overall increases surpass the rate of growth in residential population in the system, the records show.
DDSN oversees the care of thousands of those with intellectual disabilities, autism, brain and spinal injuries through a network of regional centers, county disabilities agencies and private providers.
Thus far, according to DDSN figures, 11 of the allegations have resulted in arrests or been substantiated by the state Department of Social Services, if that agency investigated an allegation. According to the records, 176 cases remain under investigation. The remainder were closed, ruled unsubstantiated or found to be standard-of-care issues.
Staff firings, according to the numbers, declined from 106 to 105.
DDSN Director Beverly Buscemi said she believes part of the increase is due to training that has increased sensitivity by providers in reporting allegations and incidents.
“We continue to serve an aging population, a behaviorally challenging population,” she said. “So we believe in letting people age in place. We try to keep people in the setting they are in or the least restrictive as possible so sometimes you are going to have behavior incidents or medical incidents because you are trying to keep them in a less restrictive setting. And that’s a balance.”
Buscemi said she does not think there is a “one-bullet” answer to the increase.
DDSN Chairwoman Eva Ravenel said the increases were “sad.”
“Our numbers are going up, and I think that’s something we need to deal with,” she said. “That is something I will be talking about.”
She said she is not sure why the numbers are increasing other than “it’s our times.”
“It drives me crazy,” she said. “Then I look at the newspaper and I see all the other numbers going on in the world, all the other craziness.”
In other business, the commission approved a new policy to charge service providers $500 fines if after a third visit by internal auditors the same problems are found in the category of health, safety or welfare.
But officials expect the sanctions to be rarely used, and Thompson said she thinks using internal audits veers away from the goal of addressing health and safety issues.
She pointed out that internal audit visits are announced and auditors look at a fraction of paperwork. She said it was not internal audits that disclosed problems with misuse of debit cards in Anderson and Orangeburg.
“I don’t think this is going to prevent exploitation,” she said. “We are not addressing health and safety.”
She said visits should be unannounced, providers should be creating their own internal controls and the focus should be on issues dealing with clients’ health or safety, such as staff-client ratios, medication errors and behavioral health plans.
“The whole point around this thing is to protect people,” she said.
Dr. Sam Broughton, a member of the board from Florence, said using internal audits with financial sanctions is only a first step at addressing the goal of better oversight.
Vice Chairman Gary Lemel agreed.
“We are addressing what the Legislature told us to put in place,” he said. “But it’s far from the only step we should take.”
Buscemi said the agency also has added some requirements to the quality assurance review process in the areas of health and safety, though she said they do not include any possible financial sanctions.
The agency will begin implementing the policy this year but will begin with initial audits, meaning auditors would have to find the same problem in an initial audit, a follow-up visit and then in a third visit before sanctions would be imposed, a process that could take years.
Lemel said the policy would not be used to penalize providers for “teeny-tiny things.”
Providers also could appeal sanctions to a panel that will include provider representatives.
The board also approved a budget request for $34.6 million in additional recurring funding in next year’s budget.
The agency, which has crafted an overall budget of $681 million for the 2018-19 fiscal year, most of it in federal funds, would like an additional $11.3 million for salary increases and for wage adjustments, its priority issue. About $10 million of that would be used to increase the hiring wage of direct support staff from $11 per hour to $12 per hour. Some would also be used for wage increases for other types of employees. The agency received $9 million this year from lawmakers to increase direct care workers salaries to $11 per hour.
Also in the request is $9.5 million for additional services, targeting aging caregivers and high-management clients; $1.8 million for psychiatric intervention and stabilization services; and $6.7 million to comply with new federal Medicaid rules.