Governor Ferguson's veto letter on various operating budget items included Rep Penner's RHC dental bill.

Governor Ferguson's explanation:

Section 203(2)(c), pages 164-165, Department of Social and Health Services, Community Dental Services at Residential Habilitation Centers 

This section requires the Department of Social and Health Services to develop a pilot program, in collaboration with the Health Care Authority, for individuals with developmental disabilities to access dental services at the state-run residential habilitation centers. Two of the four residential habilitation centers are expected to close once the census reaches a certain threshold, making this only a temporary solution to a long-term barrier to community services. For this reason, I am vetoing Section 203(2)(c). 

However, I acknowledge that individuals with developmental disabilities experience extraordinary barriers to receiving dental services and believe that a long-term solution needs to be explored. Therefore, I am directing the Department of Social and Health Services and the Health Care Authority, in partnership with representatives from the dentistry profession, to continue to develop a plan to expand access to dental services for individuals with developmental disabilities in the community. This plan must align with the state’s commitment to community-based living by exploring sustainable solutions for providers in the same communities in which these clients reside. 

News about HB 2314

2026 was a short legislative session  HB 2314 concerning dental care would have allowed us to open our dental operations to those residents in the community with developmental/intellectual disabilities to receive treatment.  Although it didn't get far in this session it may be brought up again next year.

The Reasons LVA Encourages Guardians to Place Loved Ones in an RHC

Due to the Disability Rights Washington (DRW) recent letter to Guardians of residents at Rainier School, we at Lakeland Village Associates feel it is necessary to reiterate the reasons why many guardians want their loved one in an RHC.  Below is a quote from an RHC advocate to Attorney’s in the case of Disability Rights Washington v Meneses, et al. 

 

Residents in RHCs “experience great freedom of movement and independence in a secure, supportive environment tailored to meet their needs.  Daily skills training is required and available through plentiful integrated vocational and recreational activities.  Residents receive equal, comprehensive care regardless of their ability to pay, which is valuable to them.” 

“In addition, at ICF/IID facilities there is extensive oversight of staff and staffing levels that are higher, to meet current and emergent needs better.  They have extensive medical, dental, therapy, behavioral, and nutritional services, conveniently available on campus.  Emergency care on campus is rapid and if care is needed off-campus direct communication conveys holistic understanding of client needs, allowing off-campus providers to deliver targeted treatment rather than misattributing symptoms to developmental conditions.” 

“In contrast, …clients in community settings are often isolated in homes with limited access or activities off-house. Expenses often exceed income; necessitating backfill funds that create income instability.  There is limited oversight of staff and staffing is based only on current needs.  Accessing medical care and other services involves navigating complex barriers of insurance, availability, transportations, etc. …”  “Providers commonly lack a specialized understanding of developmental disability needs and too often dismiss real medical conditions as part of the individual’s intellectual disability. 

New Law Affecting Guardianship

The new law takes effect on January 1, 2022. It imposes many new requirements for routine guardianship matters. It will be difficult for guardians to comply with this transition to the new law. It will take more time and money. The information that follows helps explain why.

 Here are a few of the changes the new law requires for routine guardianship matters that might apply in an individual case: (a) every guardian must keep a log; (b) more reports and court filings are required; (c) more information needs to be included in court filings: (d) more hearings are required; (e) more people need to be notified about filings and hearings (the Superintendent, the representative payee, the resident); (f) for out of state guardians, and those that live far away, there is now a requirement that a guardian actually visit the resident. 

 As DSHS continues to downsize the RHCs, and especially the ICF/IIDs, guardians should pay special attention to the new requirements for approving the move of a resident (or not) to a new home. In 2019, PAT A at Rainier School was closed and all the residents were moved out, many in the last couple of the weeks. Today PAT C is threatened. Guardians of Rainier School in particular need to consider whether they can meet the standard for approving (or refusing) a move before DSHS makes a request about a move. The years-long DSHS push to move residents move from ICF/IIDs is ongoing and will eventually arrive at an RHC near you. In addition, guardians will be required to provide a 14-day notice of a proposed move to the court, the resident and other interested parties before approving a move, with some limited exceptions, potentially triggering a live hearing.

 It will be very challenging for individual guardians to meet all the new requirements and standards and all the new court procedures. Although the court might be understanding because the law is new, and there is only a little money available, there is always a risk of being removed as guardian for not following legal rules. Guardians might want to consider how they can reduce this risk, especially when they are making decisions about moving residents that DSHS might disagree with. Guardians choosing to use the state's "one size fits all" court forms should consider having legal counsel review them in advance.

Careful Review of DDA Letter is Needed

Parents and guardians of Lakeland Village ICF people may have received letters about community placements. We think DDA may be trying to stay ahead of the pressure by auditors to move ICF people. We recommend that parents and guardians receiving such letters, or receiving such information at client meetings insist upon carefully reviewing placement reviews or assessments. These reviews or assessments could be designed to convince parents and guardians to move their loved one; or to convince community residential vendors or accept a person. They may even assign a "mentor" whose mission is to convince a parent or guardian to move their loved one. We recommend that parents and guardians insist upon the opportunity to visit the community residential program recommended by DDA before making a final decision. We are aware of instances in other RHCs where folks who moved returned to the RHC.

For more information contact Lakeland Village Associates President Bonnie Sullivan at bmc.sulli@gmail.com