Dear Representative Hunter and members of the Committee,

Thank you for hearing public testimony this evening on 2SSB5459. I know
that this issue has come back over and over again throughout the past
years. I have problems understanding some of the issues regarding those
who are advocating for closure of our institutions due to the fact that the
people who advocate for that action are not involved in it. No one is telling
anyone that they need to reside in an RHC yet there are people who are
taking away the guaranteed choice of those who need that level of support
to remain safe and healthy. I only wish that there would be some honest
discourse with scrutiny of the data with critical analysis. I believe if this
occurred, there would be consensus among those involved.

I have uncovered many issues in the data and reports that have been
published by DSHS. Rather than stepping up to the plate and answering my
questions regarding the analysis which is not supported by the data, I have
been accused of being abusive to the authors, censored and ignored while
supporters of SB 5459 have continued to hand out documents with false
information passed off as fact without question. This is what I find so
frustrating with this process.

Below are some actual facts that are supported by data:

1. The cost comparison that Senator Kline passed out is not actually
“apples to apples” as he states. The dollar figures used for that
analysis are taken from a Proviso report which was reported
incorrectly and the categories represented are not comparable to RHC
residents who would be moving to the community.
2. The RHC census is only declining due to the direct denial of admission
by DDD. DDD caseworkers and managers are instructed to not admit
people even if the families, guardians and healthcare teams request
admission for the health and safety of the client.
3. A true comparison would be looking at the data that I have attached to
this email. These figures came from Don Clintsman and Mark Eliason
from DDD. They are figures that they do not want to release since it
would show the true cost of care for high acuity clients in the
community.
 4. The QA surveys, both for the population which has moved
independently of the Roads to Community Living grant and the survey
required by the Federal Government to maintain the RCL grant have
not been done. That last QA assessment done for “Movers” was in
February 2009.
5. Our state is already out of compliance with CMS for lack of QA in
addition to other issues. Washington should fix what is broken before
adding more issues to the mess already present.
6. In reviewing our State Auditor’s records, I discovered thousands upon
thousands of public funds lost due to the gross mismanagement of our
DSHS department. Rather than decreasing care to keep our
vulnerable citizens safe and healthy, it would be a much better idea to
fix the issues with mismanagement within the department.
7. Susan Dreyfus talked about interviewing the parents of young children
and stating that they do not want to place their loved on in an
institution. I, too, was there when my son was young but the
difference is that I never would have said so don’t allow anyone else to
have the choice for safe and healthy care for their loved one.
8. Those children are young – it’s a much different story when those
children become teenagers and issues related to their disabilities
become more difficult to manage and the children need a more secure
and safe environment in order to stay healthy.
9. As a nurse, I have found tremendous problems with the nurse
delegation program. In many cases it is not safe nor is it legal in
many of the group homes for our citizens with developmental
disabilities. I would not risk my son’s life by having someone who
does not understand the issues managing his medications and
treatments.

SOLAs are not the same as an RHC. RHC care is comprehensive with a
team treatment plan. SOLAS do not have Active Treatment and all
services are “a la carte”. The residents will end up in ERs, Hospitals and
utilize the emergency medical response systems in great numbers just for
the fact that there are not healthcare providers on staff and there is not a
comprehensive approach to care.

Again, it is very important to maintain a continuum of care. It is best to

keep all 5 RHCs open so that residents can be close to their families. Even
with a consolidation (which is essentially a closure) the residents would be
far removed from their families.

Please DO NOT Support 2SSB 5459 – it will hurt ALL people with
developmental disabilities.

Thank you,

Cheryl Felak, RN, BSN

Disability Advocate – Parent
Because We Care – Beyond Inclusion
Seattle, WA

From: Cheryl Felak [mailto:cherylfelak@msn.com]

Sent: Tuesday, February 01, 2011 12:09 PM
To: OFM mi Public Disclosure
Subject: Budget figures for DDD clients in community

Dear Ms. Weiland,

I am doing research regarding the cost of care for our citizens with developmental disabilities who reside
in community settings. I would like to see a chart or graph with the cost per client by acuity rather than
an average cost per client. I do not need any information that violates HIPPA but only budget amounts
related to an individual. There is a wide range of services and dollar amounts. I am most interested in the
top 20-50 individuals who require the highest financial assistance per year.

Thank you,

Cheryl Felak, RN, BSN

Disability Advocate - Parent
Because We Care - Beyond Inclusion
Support a Continuum of Care
Seattle, WA

Date: Wed, 2 Feb 2011 11:16:24 -0800

From: Anita.Wieland@OFM.WA.GOV
To: cherylfelak@msn.com
CC: ClintDL@dshs.wa.gov; eliasmr@dshs.wa.gov

Ms. Felak, your request dated February 1, 2011, related to budget figures for Division of Developmental
Disabilities (DDD) clients in the community, was received via email in the Office of Financial Management
(OFM) on February 1. You requested a chart or graph with the cost per client by acuity (rather than an
average cost per client), and of particular interest are the top 20-50 individuals who require the highest
financial assistance per year.

OFM does not have a chart or graph responsive to your request. DDD staff at Department of Social and
Health Services are best able to assist you with this information. I encourage you to contact either Don
Clinstman (Donald.clintsman@dshs.wa.gov) or Mark Eliason (mark.eliason@dshs.wa.gov) directly.

With this email, I have fulfilled our responsibilities under the Public Records Act and consider this matter
closed.

Sincerely,

Anita Wieland, Public Disclosure/Records Officer

Office of Financial Management
302 Sid Snyder Avenue SW/PO Box 43113/MS: 43113
Olympia, WA 98504-3113
(360) 902-0593
anita.wieland@ofm.wa.gov
From: cherylfelak@msn.com
To: donald.clintsman@dshs.wa.gov; mark.eliason@dshs.wa.gov
Subject: FW: Budget figures for DDD clients in community
Date: Wed, 2 Feb 2011 11:21:01 -0800

Dear Don and/or Mark,

Per the suggestion of Anita Wieland I am writing to you both in hopes of receiving data for the actual
dollar amount per client rather than an average figure. I have written to you, Don, already with regards
to this. I realize that there hasn't been much time but I am hoping that these figures are available for
research.

Thank you,

Cheryl Felak, RN, BSN

Disability Advocate
Because We Care - Beyond Inclusion
Support a Continuum of Care

From: Cheryl Felak [mailto:cherylfelak@msn.com]

Sent: Friday, February 04, 2011 1:26 PM
To: Clintsman, Donald (DSHS/DDD); Eliason, Mark (DSHS/DDD)
Subject: FW: Budget figures for DDD clients in community

Dear Don and/or Mark,

I have not heard from you regarding the availability of this data. I am in need of this in order to complete
some research for disability advocacy.

Thank you,
Cheryl Felak

Date: Fri, 4 Feb 2011 13:27:49 -0800

From: ClintDL@dshs.wa.gov
To: cherylfelak@msn.com; eliasmr@dshs.wa.gov

Hi Cheryl,

We have been working on putting the data together you requested. We are awaiting our Office
of Decision Support to approve our work and we will then send it to you. Sorry for the delay.

Donald Clintsman

Department of Social and Health Services

Assistant Director
Aging and Disability Services Administration
Division of Developmental Disabilities
360-725-3421
donald.clintsman@dshs.wa.gov

Date: Fri, 4 Feb 2011 13:39:16 -0800

From: eliasmr@dshs.wa.gov
To: cherylfelak@msn.com
CC: ClintDL@dshs.wa.gov

Cheryl, here is the information we pulled together for your request.

Please let me know if you have any questions.

Mark R. Eliason

All of the clients in the data we sent last week show that these highest cost clients have a residential
level of 5 or 6. This means that they require 24 hour car care with continuous supports, both day and
night. The data that was sent also indicated that all of the high-cost individuals had acuity scores of
“High” for protective supervision.

The reason behind these costs varies from individual to individual. For example, the individual at $969.79
per day has over 496 hours per month of private duty nursing services on top of his daily contract rate of
$472 per day for residential services. This is because of this individual’s very high medical support needs.
This is in contrast to the next individual at $841.14 per day who has an acuity score of high because of
behavioral support needs related to cost of 2:1 support during awake hours.
 Protective
Behavior Medical Mobility Interpersonal
Daily Rate * ADL Acuity Supervision Residents with 3 or more
Acuity Acuity Acuity Acuity
Acuity areas of high acuity
$969.79 High Low High High High High 969.79
$841.14 High High High Medium Medium High 841.14
$754.64 Medium High High High Low High
$751.71 Low Low High None Low Medium
$737.98 Medium High High Medium Medium High 737.98
$686.64 High High High Low Medium High 686.64
$672.59 High Medium High High Low High 672.59
$638.81 High Low High Medium Medium High
$613.45 Medium High High Low None High 613.45
$600.12 High Low High High High Medium 600.12
$598.03 Low Medium High None None Medium
$580.29 Medium Medium High Low None Medium
$575.61 Low Medium High High Low High
$567.67 Low Medium High Low None High
$565.95 Low High High Low None High
$543.24 High Low High High Medium Low
$538.22 Low Medium High Low None High
$537.94 High High High Low Low High 537.94
$535.22 High High High Low Medium High 535.22
$534.96 Medium Medium High Low Low High
$526.89 High High High Medium Medium High 526.89
$517.93 High High High High Medium High 517.93
$516.65 High Medium High Low Medium High
$511.79 Medium High High Low Low High
$508.17 High High High Medium Low High 508.17
$507.55 Medium High High None None High
$507.33 Medium High High Low Low High
$505.70 Low High High Low None High
$505.18 High High High Low Low High 505.18
$497.54 Medium High High Low None High
$598.29 634.85
Average daily rate for high acuity resident in community is $624.85 by DDD’s own data. This figure does
not include all the cost of comprehensive care which one would receive in the RHC. The cost of all other
care would have to be added in on top of this figure.

NO COST SAVINGS FOR HIGH ACUITY RESIDENTS IN COMMUNITY