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$1.2 million spent on consultants, yet problems linger at Austin living center


With $29 million in federal money on the line at Austin’s institution for people with disabilities, state leaders tried something they had never done in the center’s 97-year history: They hired a consultant to run the place.

The Columbus Organization took the reins of the Austin State Supported Living Center in May 2013. The center needed a big boost after yet another scathing report by state regulators that detailed problems they believed threatened the safety of the center’s 280 residents.

But after paying Columbus $1.2 million for its services over the past year, the Austin institution is facing just as many violations as it did before the consultants arrived.

Last month, state regulators cited the Austin center for failing to meet standards in five out of eight areas of patient care, the same number it failed during its last inspection in March 2013. In a 670-page report issued last month, inspectors said that one patient nearly died because of poor nursing care; another was choked, hit, scratched and otherwise attacked dozens of times by other residents; staffers routinely neglected to tell doctors about medication errors; and employees are working 16-hour shifts because of staff shortages.

The last member of the Columbus team left Austin in mid-March.

“I think it was a costly investment that did not produce the desired results,” said state Rep. Elliott Naishtat, D-Austin, who serves on the Texas House human services committee.

Columbus officials declined to comment.

Officials with the Department of Aging and Disability Services, which oversees the 13 state supported living centers in Texas, say they are satisfied with the company’s performance and that the consultants were never expected to solve all of the facility’s problems.

Commissioner Jon Weizenbaum said the center began to improve under Columbus’ leadership. Employees are now getting additional training and support, are working more closely with residents and getting more clients involved in activities outside of their homes, among other things, he said.

Independent monitors working with the U.S. Justice Department — which has ordered the state to overhaul operations at all the centers — recently praised improvements at the Austin facility, said Scott Schalchlin, assistant commissioner for the living centers. Monitors said last month that the facility is now in substantial compliance with 33 out of 161 requirements, up from 26 in November 2012.

“You never want to have a review that’s going to produce violations,” Weizenbaum said of the regulatory inspection. “But Columbus helped us do several very important things that we’re continuing to implement now.”

State regulators say that the living center has until June to fix ongoing issues that existed long before Columbus arrived last spring, medical care and client protections among them. If it doesn’t, the facility will lose its Medicaid certification, which brings the center $29 million annually, said Aging and Disability Services spokeswoman Cecilia Cavuto.

That do-or-die mandate is unlike other threats that regulators have made to the Austin center over the years, Cavuto said. Since January 2012, state regulators have threatened to decertify the center five times for failures in resident care. And each time, even when it didn’t make the necessary changes, the Austin facility kept its money through deadline extensions or special improvement agreements.

That’s not expected to happen this time, Cavuto said.

Columbus arrives

Texas’ living centers are state-run campuses for about 3,500  people with intellectual disabilities. Some residents live in a nursing home-style facility where they receive extensive medical care. Some live in houses with other residents, where they are to be supervised by staffers. Some residents have on-campus jobs, such as stuffing envelopes, or work at businesses in the community.

After an extensive investigation, in 2009 the Justice Department demanded changes to the way the centers care for residents, and the state agreed to scores of reforms. Independent monitors were hired to oversee those changes. Meanwhile, state regulators — whose work isn’t related to the Justice Department — continued to inspect living centers for violations of federal regulations.

Columbus was hired to run the Austin center in May 2013 when f ormer center Director Charles Bratcher was forced to resign. He was the third leader to have lost the center’s top job since 2010.

If state officials had chosen to stay with the status quo, they could have simply replaced Bratcher, who made about $95,000. Instead, they hired Columbus consultant Matt McCue and a team of seven consultants charged with figuring out what wasn’t working and developing strategies to fix the problems. McCue was also to handle the daily operations.

Columbus may have taken the reins in a time of transition, but its consultants were hardly newcomers to the living centers. Since 2009, the state has paid the company more than $5.6 million to provide consulting and training services to the state supported living centers. That includes the $1.2 million the Columbus team received for its work at the Austin center.

Despite that guidance — plus that of the Justice Department’s independent monitors — the center hasn’t been able to shake persistent problems. By giving the company more control, the state hoped to speed up the center’s recovery.

“I think it’s a continual process,” Weizenbaum said. “Any organization tries to continually look at where its gaps are and how to fix them.”

During McCue’s tenure, staff training increased 27 percent, Cavuto said. Injuries, which range from minor cuts to wounds that send people to the hospital, decreased 28 percent between January and February. Employees also meet regularly during “town halls,” participate in an employee advisory committee and are encouraged to offer suggestions to leaders.

A new Austin center director, Laura Cazabon-Braly, started in January. She is the center’s fourth leader since 2012. McCue stayed several months to help transition her into the job and left on March 14.

Another critical report

The Aging and Disability Services Department’s regulatory division annually inspects the living centers for federal regulations, which dictate the way such institutions must be run. Inspectors also respond to complaints about abuse or neglect at the centers.

In March, inspectors visited the Austin center for its annual review of the facility’s operations. In its report, inspectors documented:

  • Lapses in medical care. One resident was supposed to have his fluids tracked for medical reasons, but “due to (the) facility’s failure to monitor, he was hospitalized due to seizures and almost died.” After the man returned to the living center, the staff still didn’t restrict his fluids, nor the fluids of 20 out of 24 residents who were also on such plans. Many residents, including the one who almost died, must have their fluids monitored because drinking too much can cause problems with their medications.
  • Lack of meaningful treatment. Employees regularly failed to follow set plans to provide meaningful activities that make residents more independent, such as teaching them to brush their teeth, dress themselves, or cook.
  • Medication errors. Staffers failed to ensure that drug errors for 120 out of 280 residents were all reported to their doctors. One patient didn’t receive the correct medication 21 times. When interviewed by the inspector, the nurse operating officer said that the process for handling such problems was being revamped and that the department hasn’t had any leadership for months.

 

Direct care employees blamed some of their problems on staffing problems. The center currently employs 453 direct care staffers and has 55 vacant jobs. About 8 percent of those 453 people call in every day. Meanwhile, 10-15 employees at any given time can’t work with residents because of pending investigations, Cavuto said.

Since May 2013, 10 staffers on the center’s leadership team — including the chief nurse executive and director of behavioral health services — have quit or been fired. And earlier this year, the facility had a spate of departures from its nursing staff when nine quit and one was firedbetween January and March.

Recruiting and keeping good staff is difficult because of the challenging work and competition for workers who could make more money elsewhere, Weizenbaum said. Maintaining stability at the living center is important, but sometimes change is necessary, he said.

“I want Austin State Supported Living Center to be a place that is known as one that’s turned around a difficult situation,” he said.

Inspectors also noted that staffers don’t have enough training. Throughout the report, inspectors repeatedly describe scenes of staffers trying to engage clients, helping them with puzzles, coloring with them or put their shoes on. Employees are noted trying to help residents stop spitting, rubbing their faces or slapping themselves. But when the residents won’t cooperate, staffers walk away to work with someone else, the report states.



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