July 13: Minnesota not carrying out disability reforms, court monitor says

Nearly three years after a landmark court settlement required Minnesota to revamp its services for thousands of residents with disabilities, federal authorities have found that the state's effort has been beset by bureaucratic inertia and missed deadlines.

County social workers across Minnesota have yet to be trained on how to provide individual support for disabled people moving out of institutions and into their own homes or communities, as required by the settlement. Many county workers are not even aware of the settlement and its mandates, a federal official monitoring the settlement has concluded.

In one case cited by the monitor, a 24-year-old man who moved to a group home for people with disabilities found that the staff kept his shoes locked in a closet along with those of other residents, and he had to ask when he wanted to wear them. Many other aspects of the man's life, including snack times, family visits and even use of plastic utensils, also were restricted by staff, the court monitor found.

For some people with disabilities, the monitor wrote, such services "are more life-wasting than life-fulfilling."

The report's harsh critique stands in stark contrast to the hopeful pronouncements made when the agreement, known as the Jensen Settlement, was reached in December 2011. It came amid reports that disabled clients were being unlawfully restrained and secluded at state-operated facilities, and it committed the Department of Human Services to sweeping reforms aimed at getting the disabled out of institutions and changing practices at nearly 5,000 state-licensed facilities.

While change has been slow at the local level, human services officials say they have made significant strides in reducing the use of physical restraints and shifting the agency's focus away from institutions to individual care in communities. More than 6,000 state employees have been trained in person-centered planning and other elements of the Jensen Settlement, and efforts are underway to train hundreds of county workers, they said last week. Last year, the state issued a detailed road map, known as an Olmstead plan, for ending the unnecessary segregation of people with disabilities.

The state plans to roll out dozens of other changes, including statewide surveys measuring the quality of life for people with disabilities, by early next year. "We've undertaken a lot of major changes in a very short period of time," said Gregory Gray, chief compliance officer for the department. "It's been a complete paradigm shift in how we handle individuals with disabilities."

Over the past two years, the federal judge overseeing the case has repeatedly admonished the state for its sluggish pace. In August, Judge Donovan Frank wrote "while there has been some progress, the results thus far have been disappointing and have been attended by noncompliance."

"Large number of individuals with developmental disabilities, their families, friends and loved ones," Frank wrote, "have either lost faith in the Court and the parties involved in this case or will lose faith and trust in the immediate future …"

With a team of consultants, the federal court monitor overseeing the settlement conducted detailed reviews of six people who were relocated out of a state facility for the developmentally disabled in Cambridge. The monitor found that community providers and county case managers had "virtually no knowledge" of the settlement's mandates and lacked understanding of person-centered planning, among other shortcomings.

Advocates for people with disabilities agree that little has changed in the lives of affected clients. All too often, they said, county social workers present people with a predetermined list of treatment or living options, rather than identifying the person's goals and preferences.

"They are not centering services on the person," said Shamus O'Meara, a Minneapolis attorney representing the families in the 2011 settlement. "That's wrong, and that's violative of their civil rights."

"There is still no uniform application or understanding of what we mean by 'person-centered' approaches," said David Hancox, executive director of the Metropolitan Center for Independent Living, which contracts with counties to transition people with disabilities out of nursing homes.

"So much of our system is still built around the perception that people with disabilities are needy, subordinate and unable to articulate their own needs. And that's just so untrue."