Friday, June 16, 2017

Advocates: Guardianship law should focus on well-being

Missouri law concerning guardianship and conservatorship of incapacitated adults focuses too much on an individual’s finances and assets in comparison to their well-being, said two guardianship advocates who are part of a group trying to change the law.

After the death of Carl DeBrodie, a Fulton man with mental disabilities, his family and loved ones have said they want to see changes in state law and oversight procedures to ensure no one else endures a similar fate.

DeBrodie was reported missing from Second Chance group homes at 298 Claymine Drive in Fulton on April 17. Fulton police responded to a call of a walkaway at 7:31 a.m. that day.

Volunteers searched Fulton for DeBrodie in the days leading up to April 24, when police discovered DeBrodie’s body in a storage unit at Moore EZ Storage on South Westminster Avenue.

Fulton Police Chief Steve Myers said DeBrodie may have been dead for months.

During interviews at a vigil in remembrance of DeBrodie on Tuesday, family members and loved ones said they want to see law change to include more oversight of individuals like DeBrodie. Many are asking how DeBrodie could have been gone for possibly months without anyone calling attention to his disappearance.

As officers continue their investigation into DeBrodie’s death, the circumstances surrounding his care are unclear.

Callaway County Public Administrator Karen Digh Allen became DeBrodie’s guardian in 2008.

The law requires guardians of incapacitated adults, or people who are developmentally disabled or elderly and cannot care for themselves fully, to file an annual report with the court. The annual guardianship report is intended to show the court if the guardian is meeting the requirements listed in a section of state law.

The report includes:
  • The number of times the guardian has had contact with an incapacitated adult, or ward;
  • Whether the guardian received a copy of the ward’s treatment or habilitation plan if the ward was institutionalized and whether the guardian agrees with it;
  • The date a physician last saw the ward and why;
  • Major changes in the ward’s physical or mental condition.
Court records show Allen filed annual reports for DeBrodie every year. Thirteenth Circuit Court Judge Carol England approved the most recent guardianship report from Allen on Jan. 18. Those reports are secured documents, meaning they are not available to the public.

Advocates push to update the law

David English, a University of Missouri law professor, is a member of Missouri’s Working Interdisciplinary Network of Guardianship Stakeholders, or MO-WINGS, a group of attorneys, public administrators, service providers and more trying to update the state’s guardianship law.

The law was last overhauled in 1983 and doesn’t reflect modern-day standards, which place more emphasis on an individual’s care rather than their property, finances and assets, English said. The law heavily focuses on conservatorship, he said, going back to 1830 when more importance was placed on property than the person.

Despite any modernization of the law, English said a concern still would be how the courts enforce the requirement for an annual report. Some courts don’t ensure guardians file the report and even if they do, some courts don’t sufficiently monitor the information in them, he said.

If a court sees a guardian is making little to no visits, a judge can call the guardian into court to explain the lack of visitation. English said a guardian should meet with a client at least once quarterly, but state law does not specify how many times a guardian must visit a client.

Glenn Koenen, a retired St. Louis resident, is the guardian for a friend with Alzheimer’s Disease and said he visits his friend, who he did not want to identify, at least twice a week, which is not required by the court. Koenen said he also accompanies his friend to all doctors’ visits and running major errands, such as purchasing a new refrigerator about a month ago.

Koenen said guardians have to be able to put in the time needed to properly care for that person. As a retiree, he said, he can adjust his schedule to respond to his friend’s needs.

“If you don’t have someone to make that commitment, they can fall through the cracks,” he said.

The paperwork required by the probate court is 95 percent related to Koenen’s friend’s money and 5 percent related his quality of life, Koenen said.

“They worry about the money to a ridiculous degree and they don’t seem as concerned with life and quality of life,” he said.

Incapacitated adults come under guardianship of public administrators when relatives or friends are either unable or unwilling to care for them.

English said public administrators’ offices sometimes face funding challenges, which lead to smaller staffs and bigger caseloads. He said the ideal caseload is around 40 cases.

Allen would not comment when reached by phone on Friday. She has said she’s been instructed by police not to speak to press. Allen’s Facebook page for her 2016 campaign stated she had 154 people with court-appointed guardianships or conservatorships.

Rachael Rowden, who owned Second Chance while DeBrodie lived there, has also said she will not comment about DeBrodie’s care, citing the ongoing investigation into his death.

Cathy Richards, former Boone County public administrator, said many public administrators want to see their clients more often, but lack the funding to do so. Public administrators sometimes have wards who live in another part of the state, causing transportation challenges, she said.

“Eighty to 90 percent of public administrators I worked with wanted to see them more often but couldn’t because of budget constraints,” she said. “They didn’t have anybody to pay their mileage, they didn’t have anybody to help with anything.”

The public administrator is intended to be the “last resort” of guardianship for an individual, said Dolores Sparks, advocacy specialist with the Missouri Developmental Disabilities Council, but courts will appoint a public administrator even when a capable family member is willing to care for a ward.

A ward’s safety can be increased by getting the individual out in the community or visiting with family, she said.

DeBrodie’s family and loved ones have claimed Second Chance cut off visits with him. Mary Martin, DeBrodie’s guardian and caretaker for nearly a decade, said the group home stopped her visits with DeBrodie after she called a hotline when she suspected he had been abused.

“What the Developmental Disabilities Council believes is when people with disabilities are a part of the community and family, there’s a set of eyes in community that sees you and recognizes if you had bruises on you face or if they haven’t seen you for a number of days,” Sparks said.

State agency requires monthly visits

The Department of Mental Health, which contracted services with Second Chance, has launched its own investigation in coordination with police. Debra Walker, department spokeswoman, said she could not speak about the details of that investigation.

From fiscal years 2014 to 2016, the department paid Second Chance more than $2 million for its services, Walker said in an email.

The state agency also contracted with Callaway County Special Services for case management services, requiring monthly face-to-face visits with clients, family or guardians and direct care staff. Of the department’s oversight processes, case management review is the most frequent. Callaway County Special Services and agencies like it maintain their own documentation of reviews.

Callaway County Special Services released a statement to the Tribune when asked for comment.

“We are deeply saddened about the loss of Mr. DeBrodie,” the statement said. “Callaway County Special Services is, and has been, conducting its own review related to Second Chance homes, our staff and procedures. We are unable to comment further, at this time, due to privacy and confidentiality obligations.”

The Department of Mental Health started contracting with agencies such as Callaway County Special Services several years ago after budget constraints caused the department to downsize its case management services, Walker said. The department no longer performs targeted case management of all providers, she said.

Now, department staff known as technical assistance coordinators perform annual reviews of case management agencies. The agencies submit documentation at the mental health department’s request within 30 days.

Second Chance, like other individualized supported living facilities in the state, are also required to undergo Medicaid waiver certifications every two years through the mental health department to ensure providers are complying with clients’ legal rights, health, safety and requirements of these facilities. Clients, direct care staff and agency management are interviewed in this process.

Second Chance received certification first in 2006 and every two years after. Violations were noted in 2008 and 2016, but corrected by Second Chance in the appropriate time frame.

The Department of Mental Health also conducts a provider relations review with case management agencies every three years and a quality of service review that uses a random sample of 400 individuals that targets health, safety, inclusion and self-advocacy.

Individuals with more serious medical needs also can receive an optional review of their registered nurse.

The Department of Mental Health recently released two investigation reports conducted after receiving complaints about Second Chance employees who allegedly threatened clients.

Both investigations were substantiated, Janet Gordon, the department’s records custodian, previously said in an email.

Walker said in an email that investigations are triggered by the department’s regional office staff and/or contracted agency employee reports, complaints from the Department of Health and Senior Services and/or Department of Social Services hotlines that mention a Department of Mental Health consumer or reports of abuse or neglect submitted through the mental health department’s Constituent Services Office.

Misuse of consumer funds, physical abuse, neglect, sexual abuse or verbal abuse that are substantiated lead to disqualification of an agency employee, Walker said. No disqualifications resulted from the Second Chance investigations, she said, because department regulations, as of August 2012, do not disqualify an agency employee unless he or she had two or more substantiated charges within a 12-month period, she said.

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Advocates: Guardianship law should focus on well-being

1 comment:

Jeannie said...

Money is always the focus.