Tag Archives: TBI Waiver

Thoughts on the New York State Department of Health

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The content of this essay may surprise some. Wouldn’t be the first time. On the whole, I happen to like the New York State Department of Health.  In all the years I’ve interacted with them,  with only one minor recent exception, the people at the DOH have been all I could hope for. No, I don’t always agree with every single policy, but so what?

What I can confidently say about my relationship with the DOH when it comes to the world of brain injury survivors in my state is this; I believe they genuinely do care and, I believe, they are doing their best and working far harder for their constituents  than they are given credit for.

A long time ago I went to work for a man who was used to being surrounded by mostly sycophants. Early on I told him, “Please understand that brown does not wear well on my nose.” I’d later learned this was something he liked about me. Anyway, brown didn’t wear well then and it doesn’t wear well now, so anyone doubting the sincerity of what I am saying here is mistaken.

The Traumatic Brain Injury Waiver in  my state is, when all is said and done, a blessing. Does it have its problems? Sure. After all, any program taking on the significant challenge of helping people with brain injuries regain their independence and live in the community would. Moreover, we are all human beings who have never worn the countenance of perfection and never will and that’s okay. I can tell you that when I’ve sat across the table from people in the DOH, people like Mary Ann Anglin, Beth Gnozzio, Mark Kissinger, Lydia Kosinksi and more, I am sitting across the table from people who genuinely care.

While the experience of living with a brain injury is not easy on any front, it would be far more difficult for the 2,700 or so people now on the waiver, which is managed by the DOH.

If I had my way all those just mentioned would come to the brain injury summit scheduled for next month. They’re certainly more than welcome.

Feeney Again: Understatements & Reasons

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An understatement: New York State brain injury survivors and their families will be up arms if Timothy J. Feeney and his staff have any involvement in the Statewide Neurobehavioral Project; a project designed to help providers of services under the Traumatic Brain Injury Waiver. In fact, if there were an Olympic event for understatements and you uttered the preceding sentence, you might just win gold.

I was asked recently if I knew if a contract had been signed that would bring Feeney back.  While I’ve heard from an array of sources that Feeney and his minions are scampering around claiming they are under contract, I do not think the contract has been signed. If you’re a regular reader of this blog you’ll recall that for 15 years while working under contract with the department of health, Feeney misrepresented his educational credentials to New York State Officials, people with brain injuries of all ages, children with disabilities, educational institutions, and healthcare providers. It may be that he did so in courts as well. An avenue of investigative interest for sure. 

If you think having the bogusness of his credentials exposed in 2008 by this writer dissuaded him from continuing the ruse, you’re wrong. Feeney continued and continues to present himself as having a PhD and a Masters Degree. The truth?  He has neither. Feeney was issued these “degrees” by a business called Greenwich University; a dip0loma mill. “Degrees” from Greenwich are not valid anywhere in the world.

Let me just say that I’ve known people with real doctorates and real masters degrees and my father taught at Columbia University and John Jay College of Criminal Justice. People pour their blood, sweat and tears into getting these degrees.

If I am right that the contract has not been signed, I believe there are several reasons for this. Most will not surprise you – one might.

  • First, and likely the least surprising, the whole country is looking to conserve Medicaid dollars to the extreme (keep in mind Feeney was essentially being paid with your tax dollars).
  • Second, everyone knows that allowing Feeney and those linked to Feeney back into the fold would be a clear statement to survivors of brain injuries, their loved ones that they are second rate citizens. Why else anyone allow someone who misrepresents his credentials and those who know this and support him back into the fold? It would be like asking a geologist to oversee neurosurgery across the state (my apologies to the geologists among us).
  • Third, if Feeney were again part of the neurobehavioral project and investigations resulted in criminal and or civil charges against him down the road, how would anyone look if they’d entered into a contract with him, directly or indirectly, having been fully informed of his misrepresentations before doing so?! Wouldn’t any parties falling into this category find themselves on the receiving end of some fairly zealous and plausible litigation?
  • However, there is a fourth reason, and this is the one that might surprise you. While the public at large is quick to condemn government agencies simply because they are government agencies, such condemnations are not always accurate. All indications are that those in the New York State Department of Health genuinely do care about the quality of services being provided to survivors of brain injury in the state. And that is good news for us all.

 

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The TBI Waiver: Seeking a Household Unified

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New York State’s Traumatic Brain Injury Waiver came into existence in 1995. Essentially it is an admirable Medicaid program that offers a set of services that help people with brain injuries remain in the community and, not incidentally, costs far less money than keeping people in nursing homes.

Recently I am hearing some deeply disturbing  things, including, but not at all limited to, the following:

    • Survivors of brain injury are being told their services will need to be cut by contract employees of the New York State Department of Health who are not experts in the field of neurology and therefore would appear to be making decisions they do not appear qualified to make.
    • There is a service offered by the waiver called Independent Living Skills Training. According to the DOH’s waiver manual ILST “services may include assessment, training, and supervision of, or assistance to, an individual with issues related to self-care, medication management, task completion, communication skills, interpersonal skills, socialization, sensory/motor skills, mobility, community transportation skills, reduction/elimination of maladaptive behaviors, problem solving skills, money management, pre-vocational skills and skills to maintain a household.  ILST services are individually designed to improve the ability of the participant to live as independently as possible in the community. ILST may be provided in the participant’s home or in the community. This service is provided on an individual basis.”          However, I am hearing that survivors are having their ILST services cut against their will. Now I am sure that were one to look closely at those receiving ILST services there may very well be cases where services should be reduced, or stopped altogether. However, the problem, and it is a potentially dangerous one, is that the decisions to cut these services appear to again being made by people not qualified to make them.
    • There is another waiver service called CIC, Community Integration Counseling. CIC is essentially talk therapy designed to help a person living with a brain injury come to terms with living life with brain damage. Now I am hearing some survivors are being told to turn to the mental health community for their counseling. Again, dangerous. A brain injury is an injury, not an illness. Period.
    • I have also had some reports that some New York DOH contract employees are saying the waiver was never meant to be a permanent support for people with brain injuries. First of all, that is disingenuous, secondly, brain injuries do not entirely heal, and there are lifelong deficits some of us live with that will require support for us to remain in the community.

Now, I would be wrong to villainize the New York DOH as a whole. Like all government agencies that are under pressure to cut costs. All the more reason they deserve advocates standing with them against any and all forces that continue to put the quality of lives and the lives themselves at risk. Therefore all parties need to be at the table: the New York DOH, the Kahrmann Advocacy Coalition, the New York State Brain Injury Association and the Providers Alliance, a group of  40 or more waiver service providers.

Everyone involved in regulating and providing services as well as advocacy for people with brain injury should be at the table looking to remedy things. No one party, including the DOH, should be made or choose to go it alone.

Lincoln was right when he said, “A house divided against itself cannot stand.” A household unified can stand and then some.

 

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Feeney, the White House, Editors, Elected Officials & Criminal Investigations

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If New York State enters into a contract allowing Timothy J. Feeney to once again impact the lives of survivors of brain injury and those who provide services to them, several things will take place. Before I get to them, let’s review some of the facts.

  • Fact: For more 15 years now Timothy J. Feeney has misrepresented his educational credentials to New York State Officials, people with brain injuries of all ages, children with disabilities, educational institutions and healthcare providers.
  • Fact: Feeney’s so-called PhD and so-called Masters Degree were issued by Greenwich University, a now defunct diploma mill whose degrees are not recognized as valid anywhere in the world.
  • Fact: The New York State Department of Health now knows Feeney has misrepresented and continues to misrepresent his credentials.
  • Fact: STIC (the Southern Tier Independence Living Center), the provider likely to be awarded the contract and give the work to Feeney and his people, has been fully informed of Feeney’s past and present misrepresentations.
  • Fact: STIC and the New York State Department of Health have been informed that Feeney is under contract with the Fort Ann Central School District in New York’s Washington County to work with children (children!) with disabilities , where he is again misrepresenting himself in the process. Fort Ann has been informed as well and has continued working with Feeney; so much for putting the children first.
  • Fact: If Feeney is part of the contract he will be getting paid in taxpayer dollars, Medicaid dollars which means your money and mine will be paying a dishonest individual.

If New York State enters into any contract which allows Feeney to be part of the Statewide Neurobehavioral Project, an entity that wields enormous power over the lives of survivors of brain injury and their families as well as those who provide services to them, then New York and STIC are making it clear they have no respect for people with brain injuries. Why on earth should those of us who live with brain injuries have to deal with someone who lies about who they are? Someone who is unqualified?

And what was the dysfunctional thinking and the behind the scenes backslapping that went on that led to the decision to contract with someone everyone knows is a fraud? What did not go on behind the scenes was any real concern for those of us who live with brain injuries, our loved ones, and the honest healthcare providers that do give a damn. What did not go on was any respect whatsoever for the hard-earned taxpayer dollars that will pay Feeney and his crew.

Back to what  will take place should Feeney and his people be involved in the contract.

  • Letters will be written to the editors of all daily newspapers in New York State and neighboring states detailing the actions of the State and Feeney and STIC.
  • Letters will be sent out to a wide array of State and Federal officials, including President Obama, Healthcare Secretary Sibelius, as well as various members of law enforcement given that historically Feeney has interacted with the judicial system again misrepresenting himself in the process.
  • Last, but by no means least, letters will be sent to CMS (Centers for Medicare & Medicaid Services), the Federal Agency the oversees the spending of Medicaid and Medicare dollars in all states, and an agency that will not be pleased to here New York has knowingly entered into a contract with someone they know is misrepresenting his credentials.

The ball is in the court of the State and STIC. We’ll see what happens.

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We Are Not Cottage Industries

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A few years ago I was talking with a woman whose husband suffered a brain injury. She said, “The moment he got his disability he became a cottage industry.”  While the definition of a cottage industry involves work done at home, the point she was making was and is spot-on accurate. People with disabilities are often seen as a way of making money.

As those of you who are regular readers this blog know, I live with a brain injury and have worked in the field for 15 years, for the most part in the arena of New York’s Traumatic Brain Injury Waiver, a welcome form of Medicaid reimbursement that funds services designed to help survivors of brain injury remain in the community and grow their independence.  Companies and individuals who provide waiver services run from the gamut, from superbs to slugs. The superbs are those who really work to help someone grow his or her independence which results in their actually needing less services over time. The slugs are those who pile on as many services as possible, often more than any person, brain injured or not, can handle, or, for that matter, needs. The slugs do all they can to keep survivors in their program and have no intention whatsoever of helping them increase their independence.  I call it community-based warehousing.

A perfect example of a slug provider at work was an example cited in an April blog post.

“I know someone who lived with a brain injury. She is extremely bright and nobody’s fool. Were she in a coma she could likely outwit 99 percent of the people I know. Anyway, she was attending a day program and made it known she wanted to get a part time job. So the program tells this woman that they will clear out a little office space they have and set it up with candy and soda so she can sell the items a few hours a week and she can keep some of the money. This woman said to me, “Do they think I’m stupid or what? Do they think I don’t know that the only reason they’re offering this is so they can bill for the hours I’m in selling their damned candy?” In other words, all this Albany-based provider cared about was not losing the money they would lose if this woman had a part time job in the, wait for it, community!”

This same provider enlisted some in their program to clean their offices, paid them a pittance, and reported them as people that had successfully returned to the workforce. Oh, the program billed Medicaid for the time the survivors were cleaning their offices. Bill trumps humanity on too many fronts.

We are not cottage industries, we are human beings.

There are some extraordinary providers who know this. Cortland Community Re-Entry Program in Cortland is wonderful, Living Resources in the Albany area is too, and  so is the Long Island-based program, RES. They know we are not cottage industries and they also know something else too. By providing high quality services, people with brain injuries grow their independence, the word gets out, and more people want to go to their programs.

If you are inclined to blame the current state of affairs solely on the New York State Department of Health, don’t. Like most state agencies,  in my view, they are, through no fault of their own, understaffed and overworked. It is not easy for them to send out the number of survey teams they’d like to in order to take the slugs to task and praise the superbs.

The responsibility of making a slug a superb falls on all our shoulders. The dysfunction of dehumanization needs to be brought into the light. If you are someone who knows of this type of dysfunction and you are unsure of what to do with it, or you are scared of what might happen if you do act, drop me a line.

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