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South Carolina

Task Force

In November 2000, the governor issued an executive order to establish the South Carolina Home and Community-Based Services Task Force and directed it to develop a plan. The task force includes 33 members representing state agencies, service providers, consumers, families, advocates, and members of the state legislature. The task force was divided into three workgroups that parallel the state government organizations that serve people with disabilities in institutional and community settings. The three workgroups are 1) the Department of Disabilities and Special Needs (DDSN); 2) the Department of Mental Health (DMH); and 3) the Department of Health and Human Services (DHHS).

The Plan

The final plan was submitted to the Governor on August 31, 2001. The report is available online at www.scddc.state.sc.us.

The final plan is a composite of the recommendations made by the three workgroups. A set of "core principles" guided the task force in reviewing the state's existing services and making recommendations for change. Those core principles are nurturing human potential, choice and self-determination, autonomy and consumer-direction, flexibility, respect and dignity, integration, empowerment, equity, availability, prevention, quality, health and safety, responsiveness, efficiency, accountability, advocacy, and cultural competence. Key recommendations from the report follow:

• Assessment
• The task force recommends developing an independent assessment process to offer people opportunities to live in a home or community-based setting. The first step in the assessment process should present a choice: where, how and with whom do you want to live? The next step will be an assessment of needs to make the preferred option possible.
• Those Currently in Institutional Settings
• Making the Transition to the Community: All those living in institutions who wish to move to a community setting should be moved within a year of plan implementation, barring health and safety issues. Sufficient bed reserve capacity should be maintained for up to 90 days to allow the re-admission of people whose community placement has not been successful.
• Quality of Institutional Care: The quality of institutional care should be improved in areas such as food, clothing, personalized spaces, day activities, employment and recreation. Consumer satisfaction and family satisfaction should be monitored.
• Those at Risk of Being Institutionalized
• Individuals deemed to be at risk of institutionalization should be linked with a care/service plan and be monitored.
• Health professionals should explain alternatives to institutionalization to at-risk people.
• A comprehensive, statewide crisis intervention and support system should be developed to prevent unnecessary institutionalization (e.g., community-based crisis respite beds).
• All those who are seeking nursing home placement, regardless of their funding source, should be assessed, prior to nursing home admission.
• Waiting Lists
• Waiting lists should be developed, maintained and monitored.
• An unmet needs list should be created to document the needs of those on waiting lists and additional needs to those receiving some services.
• Data Systems and Collection
• An interdepartmental task force should study the feasibility of adopting common computer hardware and software to assist with tracking individuals who need and receive care.
• Quality Assurance/Outcomes
• Quality should be defined and measured in terms of the personal goals, outcomes and satisfaction of the individual consumer.
• A complaint system for in-home care should be developed, similar to an ombudsman program.
• Community Services and Supports
• A multi-system team, consisting of consumers, families, stakeholders, state agencies, and private providers, should continue to work together to address the needs of consumers.
• Community resources should be assessed.
• A variety of service coordination options should be available to consumers, including independent, agency-based, team coordination and self-directed service coordination.
• Direct care worker wages should be adequate to recruit and retain quality personnel.
• Specific recommendations are offered for increasing the number of housing units available in community settings to allow consumers to move from institutions into the community or from one community setting to another, less restrictive setting
• Transportation services should be improved to include door-to-door and escort provisions, and CMS policies toward non-medical transportation will be investigated. Public transportation and transportation alternatives also will be improved. One recommendation calls for labor and mileage reimbursement to friends and family who provide transportation for consumer and family choice, control and autonomy.
• Education in self-advocacy, continued financial support to consumer advocacy groups, and supported employment programs and services are recommended.
• A greater emphasis should be placed on supported employment programs.
• Recommendations also are made in the areas of day activities, family and caregiver supports, respite, and assistive technology.

Implementation

There was no legislation related to Olmstead during the 2002 legislative session.

The state has eliminated some barriers that prevented individuals from successfully making the transition into community settings through agency collaboration and by establishing a program that allows the funding to follow each individual.

Securing funding to continue running the programs is the most significant challenge to date. In addition, strengthening the community networks to prevent unnecessary institutionalization of individuals with disabilities has been an ongoing challenge, but it is slowly improving.

There are no pending lawsuits related to the Olmstead decision.

South Carolina received a $2.3 million Real Choice Systems Change Grant. The money is being used for the Options for Community Living Program, to improve accessibility to comprehensive, up-to-date information about services and resources in the community for older adults and people of all ages with disabilities. The program also will increase options for consumer-directed care.

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