Kentucky Protection & Advocacy
Our Mission
To protect and promote the rights of Kentuckians with disabilities
through legally based individual and systemic advocacy and education.
Who we are and what we do
Protection and Advocacy (P&A) is an independent state agency that was
designated by the Governor as the protection and advocacy agency for
Kentucky. P&A's staff includes professional advocates and attorneys.
HISTORY OF THE INSTITUTIONALIZATION OF INDIVIDUALS WITH
MENTAL ILLNESS IN KENTUCKY
Kentucky State Hospital
Kentucky State Hospital
Danville, Kentucky
Frankfort State Hospital
HISTORY OF THE INSTITUTIONALIZATION OF INDIVIDUALS WITH MENTAL
ILLNESS IN KENTUCKY
Public Psychiatric Hospitals
Eastern State Hospital – Lexington, KY
Central State Hospital – Louisville, KY
Western State Hospital - Hopkinsville, KY
Appalachian Regional Hospital – Hazard, KY
The Olmstead Decision
• May 1995: Suit filed in US District Court in Georgia
against state officials, including Department of Human
Resources head Tommy Olmstead
– The plaintiffs: two women with dual diagnoses of
mental illness and mental retardation, who had a
history of institutionalization
– Both women were appropriate for community-based
treatment, but remained hospitalized.
– Lawsuit challenged their continued confinement
violated Title II of the Americans with Disabilities Act
(ADA) and Section 504 of the Rehabilitation Act
The Olmstead Decision
• June 1999: Supreme Court issued its opinion (6-3) in
the case, stating that:
– Continued confinement violates Title II of the ADA
– States shall, when deemed appropriate, make every
effort to accommodate the needs of individuals with
disabilities in the community
– Based on Section 504 which states, “A public entity
shall administer services, programs, and activities in
the most integrated setting appropriate to the needs
of the qualified individuals with disabilities.”
DISCHARGE OF INDIVIDUALS WITH MENTAL ILLNESS
FROM PUBLIC PSYCHIATRIC HOSPITALS IN KENTUCKY
Protection & Advocacy Efforts
 Representation of Individuals
 Participation in Transition and Discharge Planning
 Filing of OCR Complaints
Voluntary Compliance Agreement Between
DMH/MR and the Office For Civil Rights
 Under Section 504 and Title II of the ADA, DMH/MR is
required to administer services, programs, and activities in
the most integrated setting appropriate to the needs of
individuals with mental illness.
 Unnecessary institutionalization of individuals with mental
illness constitutes discrimination under the ADA
 Other:
• Concerns about adequacy of the assessment process
• Absence of formalized transition plans
• Inadequacy of community resources/providers to
meet the needs of persons with mental illness
Personal Care Homes (PCHs) In
Kentucky
• Long Term Care Facilities
– Defined in Kentucky Revised Statutes KRS
216B.510
– Regulated under Kentucky Administrative
Regulation 902 KAR 20:036
– Licensed and Regulated by the Office of the
Inspector General per KRS 216 et seq.
PCHs In Kentucky
• There are 6,490 Personal Care Home Beds
statewide
• 4,479 are free-standing beds and not part of a
nursing facility
• Average overall occupancy is 79.88%
• Location
• Physical Appearance
• Size
PCHs In Kentucky
• Some of the services to be provided:
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Room accommodations
Housekeeping and laundry
Maintenance services
Three meals per day and snacks
Soap, clean towels, wash cloths, and linens
Planned individual and group activities
Recreational room or space
Reading materials, radios, games and television sets
PCHs In Kentucky
• Rights of individuals in PCH’s include, but
are not limited to:
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Right to be safe
Right to be treated with respect and dignity
Right to privacy
Right to receive and send unopened mail
Right to access telephone for making/receiving calls
Right to participate in social, religious, and community
groups of choice
– Right to keep and wear own clothing
PCH – Golden Years in
Jenkins, Kentucky
PCH – Breckinridge Manor in
Cloverport, Kentucky
PCH – Breckinridge Manor in
Cloverport, Kentucky
PCH – Breckinridge Manor in
Cloverport, Kentucky
PCH – Sunny Acres in Calhoun,
Kentucky
PCH – Sunny Acres in Calhoun,
Kentucky
PCHs In Kentucky
• Population served:
– Predominantly individuals with mental illness
– Individuals with intellectual and
developmental disabilities
– Individuals with brain injuries
– Individuals released from jail or prison
– Age range from 18 and above (though 16 is
lower age limit)
Payor Source For PCHs
• The majority of persons living in PCHs receive SSI which
is currently $674 per month.
• The state supplementation program (as required by
federal law) pays an amount from state general funds to
supplement the SSI payment for persons living in
personal care homes.
– Currently, PCHs costs $1,194 with $520 paid in state
funds and $674 in SSI monies.
– The PCH must allow the person to retain $60 per
month as a personal needs allowance.
2009 Information Reported for
PCHs
• 3,073 individuals received the state
supplement and lived at PCHs
• Total expenditures reported $18,650,690
(state general funds)
Additional Supplement To
PCH’s
• PCHs with populations of persons with MI or ID/DD that
exceed 35% receive an additional amount (50 cents per
day).
– Must be certified by OIG as having that percentage of
population and following the other requirements of the
regulation:
• staff training
• specialized group activities
• specified medication administrator
• licensed nurse/CMT for 1st and 2nd shifts
• Thirty-three of the 83 free-standing PCHs are certified to
receive this additional amount.
P&A Efforts at PCH’s
• 2009—P & A provided training on Long Term Care
Rights, information about guardianship and employment
to individuals living at 20 PCHs.
• 2010—P & A staff and members of our PAIMI Advisory
Council (PAC) conducted rights trainings at 24 PCHs.
– A total of 540 individuals attending the trainings.
– Information about employment, voting, guardianship,
including restoration of rights, was provided.
P&A Efforts at PCH’s
• 2011—P & A staff and PAC members are visiting 20
PCHs across the state.
– Staff will complete a questionnaire for 20% of the population and
a one page monitoring form about the facility.
– These data will then be entered into a Statistical Package for
Social Sciences.
• Also during 2011 P & A staff conducted investigations at:
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Golden Years in Jenkins
Gainesville Manor in Hopkinsville
Hilltop in Science Hill
Frasures’ in Ashland
Breckinridge Manor in Cloverport
P&A’s Preliminary Findings at PCHs
As a result of site visits and personal interviews
conducted, the following was found:
• Abuse/neglect/exploitation
• Not home-like
• Institution-like
• Desire for a different living arrangement
• Limited activities
• Limited access to community
Personal Accounts From
Interviews
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“I feel lonely and abandoned.”
“I would like to go to the Dollar Store.”
“I do not receive my personal mail.”
“I do not get enough food to eat.”
“We are not allowed to leave the facility after 3:00pm.”
“This is not a home.”
“If you refuse your medication, you are threatened with
hospitalization or privileges are withheld.”
“I cannot call my friends or family.”
“I do not get to purchase my clothes.”
“People here eat in shifts.”
“This is better than the streets.”
DISABILITY ADVOCATES, INC. V. PATERSON
Indicia of Institutionalization
Daily Life
• Medication administration
• Meals
• Receipt of personal needs allowances
• Visitors
• Daily activities at the PCH
• Leaving the PCH
– For doctors/mental health providers
– For jobs
– For fun, entertainment, visits, dining out
– Organized trips by the PCH
• Medical treatment in the PCH
• Curfews or locked doors
DISABILITY ADVOCATES, INC. V. PATERSON
Indicia of Institutionalization
Physical Plant
• Common areas
• Sleeping areas
– Decorating
– Choosing roommates
• Posted menus
Final Thoughts
• Progress to date
• Musts for the future:
– Ensure integrated housing for persons with mental
illness
– Ensure access to other needed services and supports
for persons with mental illness
– Re-think utilization of current resources
• Recovery means living like people without a mental
illness live; such as, having your own place to live, a job,
access to health services, and transportation.
Contact Information:
• Marsha Hockensmith, Director
• Kentucky Protection and Advocacy
• 100 Fair Oaks Lane, Third Floor
• Frankfort, KY 40601
• (502)564-2967 or 1-800-372-2988
• http://www.kypa.net
Welcome ~ Sheina Murphy
• Sheina Murphy is from Paducah, Kentucky.
• She is a Peer Specialist and provides training to law enforcement officers
using the Crisis Intervention Training (CIT) model.
• She is also member of numerous councils and boards including:
– The Department for Medicaid Services Advisory Council for Medical Assistance
– The Protection and Advisory for Individuals with Mental Illness Advisory Council
– The Kentucky Mental Health Coalition