Politics

Missourians with disabilities languish in hospitals and jails

Published

2 years ago

March 22, 2023

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On a Friday afternoon in late December, Geri Curtis received a disturbing phone call informing her she had only five days to find a new home for a developmentally disabled person.As part of her job as public administrator for Livingston County, she had become legal guardian of a person with severe developmental disabilities two months earlier. The person, autistic and unable to speak, was living in a residential support facility in Jackson County.Soon after she became the legal guardian, Curtis received notice from the facility that the person had to move within 30 days because of aggression.Despite the efforts of the case manager at a regional office of the Missouri Department of Mental Health, nothing was available. Just before Christmas, Curtis got the call informing her that she had just five days left to find a new residential placement.When the five days passed, the provider took the person to a hospital emergency room.And that is where they have lived since.“Our hospitals are not dumping grounds for these individuals but the hospitals are full of our clients,” Curtis said.At the beginning of March, there were 650 adults with developmental disabilities in what the Department of Mental Health calls “inappropriate placements.” There are 39 residing in hospitals, plus a handful in jails and homeless shelters, representing the most critical cases impacted by widespread staffing shortages among local non-for-profit organizations.“This is a major problem,” Curtis said, “and it is not going to be fixed if we all put our head in the sand.”Two initiatives are underway to fill those vacancies. Associations representing those local agencies have launched a statewide recruitment campaign for direct service employees. And they are asking lawmakers to increase the base wage for those jobs from $15 to $21 an hour, as recommended by a study completed last year.When lawmakers return to work this week, a top agenda item for the Missouri House will be completing work on its revisions to Gov. Mike Parson’s $51.6 billion state budget proposal. The higher rates would add $400 million – including $185 million in general revenue – annually for the program already expected to cost $1.75 billion in the coming fiscal year.At Community Opportunities in Troy, administrator Mary Sullivan-Thomas has a waiting list for services that fluctuates between six and 10 people with developmental disabilities. She would hire 10 more staff if she could find applicants.There are hundreds of other Missourians in limbo because the mental health department itself is dealing with massive staffing shortages. As of early March, there were 229 people in county jails deemed incompetent to stand trial with court orders for treatment.Because it sees no chance of getting large numbers moved to its hospitals, the department is asking for legislative authority to deliver treatment in the local jails or on an outpatient basis if the person can be safely released.At a cost of $2 million, the department will contract with providers for programs in St. Louis, St. Louis County, Greene County and Jackson County and create two mobile teams, Director Valerie Huhn said.Clay County Sheriff Will Akin, who on March 9 had five people detained in his jail awaiting transfer to the department, is lobbying to be added to the list. Keeping those people detained is extra work for his jail officers, he said, and is not in the best interest of those who desperately need help.“That’s a challenge for us,” Akin said, adding that these individuals are in need of treatment “and we’re not able to get it to them, because we don’t have those capabilities.”

Rudi Keller

Missouri Independent The group homes operated by Community Opportunities in Troy. Each has rooms for five clients.

‘Live their best life’Kristin Nobus worked for Sam’s Club for 17 years before she took a job as a community skills teacher at Community Opportunities about a year ago.She works in the day center on the campus that also includes two group homes and administrative offices. A typical day, she said, begins with exercise videos and then they pack and deliver Meals on Wheels in the community.Sometimes she is assigned to help a client in the evening.“We usually fix dinner and help them get their showers and just get them ready for bed so that they can have a nice relaxing evening,” Nobus said.She was recruited, Nobus said, by a former co-worker. The pitch – novel experiences, clients with sweet personalities and less stress – was attractive, she said. The pay is comparable to her wage at Sam’s, she said, and the work atmosphere is supportive.“It is not like people are trying to stab you in the back here; everybody just works together as a team,” Nobus said.Community Opportunities provides rooms for 10 adults in two group homes and supports 13 more individuals living in apartments and homes in the community among its 300 total clients.A direct support employee doesn’t need any special credential, she said, but must be patient, have a good sense of humor and be prepared for anything that can happen to a person in life.“As a direct support provider, you’re a counselor, a teacher, a nurse, a chauffeur, you have all these different roles,” Sullivan-Thomas said.The best candidates for employment with an agency like Community Opportunities, Sullivan-Thomas said, are people comfortable providing one-on-one help to others. The issue, even for the best candidates, is the starting pay.“Right now, you can make 15 bucks an hour working at Starbucks,” Sullivan-Thomas said. “So, do you want to work at Starbucks and get 15 bucks an hour? Or do you want to work in a day program with people with developmental disabilities and help them in the restroom?”The state contracts with almost 1,200 local agencies to serve adults with developmental disabilities. Some, like Community Opportunities, are supported by local property taxes still identified by the 1960s authorizing legislation as “Senate Bill 40” levies.The Division of Developmental Disabilities provides services to almost 41,000 Missourians, including more than 7,600 receiving residential services in shared or supported living or group homes. The division’s funding is a mix of general revenue and local tax money used to leverage federal matching funds.The mental health department’s budget request didn’t include funding to implement the new rate study because it was completed too late in the year, Director Valerie Huhn said in an interview with The Independent. But the budget does include initiatives to help reduce staffing needs and incentives to increase training and retention.One aspect of what the department calls value-based programs would use remote monitoring instead of staff for overnight shifts. The clients have greater independence and the agency can redirect staff to more productive work, Huhn said.“You are taking that person out of the home and taking eight hours, seven days a week, where they can work another shift for someone else and give them access to care,” Huhn said.Child care providers and nursing homes are among the other employers competing for the workforce with experience and training suitable for developmental disabilities programs, Huhn said. There are very few spare employees in Missouri’s tight labor market – unemployment in January was 2.7%, with only two counties above 5%.“Our labor force that we utilize is in a very high demand right now,” Huhn said. “And there’s a lot of fields that can be less demanding than what we are asking of people.”In Troy, Sullivan-Thomas must compete with the St. Louis-area labor market. If someone is a good fit for the job, she said, they usually stay with the agency a long time.“When we’ve looked back at our statistics, it seems as though if people are here two years, then they tend to stay,” she said.When agencies don’t have staff, or people who need help can’t navigate the service network, local agencies face enormous challenges. Community Resource Center in Chillicothe operates a shelter with 12 beds, and two are currently being used by men with developmental disabilities, Director Katie Hobbs said.One of the men is estranged from his family and is not enrolled in disability or medical programs. Hobbs said she has been working with him to obtain services,but he needs a permanent placement.“I can’t just keep him here, but it is going to be very hard,” Hobbs said. “A lot of facilities will not take him without a guardian. He does not have $1,500 to get a lawyer.”When the division has a client in a homeless shelter, Huhn said, it will keep in daily contact to check on the safety and welfare of the person as it seeks a placement.“We call them critical for a reason,” Huhn said.The fate of the rate increase could depend on how willing the House Budget Committee is to dip into the massive surplus of general revenue and other funds that is approaching $7 billion.In a recent hearing, state Budget Director Dan Haug warned against committing the surplus to recurring costs.“‘Those are one-time funds we would be very concerned with using for ongoing provider rates,” Haug said.Several lawmakers appeared ready to fund higher rates. Rep. Steve Owens, R-Springfield, asked whether the state should pay more if current rates weren’t enough to fill the jobs.“If the funds are there, obviously we are not offering a price, a payment schedule enough to attract those people,” Owens said.And Rep. Deb Lavender, D-Manchester, said it’s time to tap the surplus to retain staff that could be attracted away.“If we don’t pay these people now, we are not going to have them next year,” Lavender said.Sullivan-Thomas said she sees higher rates as the only way she’ll fill her vacancies.“It’s frustrating that we don’t get the appropriations that we need from the legislature to have adequate funds to hire more staff and to pay them commensurate with the responsibilities of their positions,” she said.

Rudi Keller

Missouri Independent Jessica Bax, director of the Division of Developmental Disabilities, speaks during a March 8 House Budget Committee hearing with Department of Mental Health Director Valerie Huhn, center, and Molly Boeckman, director of administrative services

‘Not a safe environment’On an average day, the Clay County Jail has eight detainees with behavioral health issues waiting for a bed to come open in a Department of Mental Health hospital. Some, like one transported to the department on Feb. 28, have a dual diagnosis of a developmental disability and behavioral issues.“Just being ruled incompetent to stand trial can take an unacceptably long time,” Clay County Sheriff’s Department spokeswoman Sarah Boyd wrote in an email. “One man who has autism and is nonverbal was booked into the jail on Nov. 13, 2021, and wasn’t declared incompetent until Nov. 10, 2022. With much pleading by our detention staff, he went to DMH on Feb. 28, 2023.”The inmates must be isolated from the regular jail population, which often means confinement to a cell 23 hours each day.“Many of them have severe hygiene issues, from refusal to bathe to spreading feces,” Boyd wrote. “One inmate awaiting DMH treatment must be regularly removed from his cell – which is often a physical struggle – so staff can clean the feces from it.”Those issues are why Akin is so eager to join the program for jail-based competency restoration.“It’s not a safe environment for the inmate,” Akin said. “It’s not a safe environment for the employees. And it’s not a safe environment for those who are in the general vicinity, which are, you know, other inmates.”The Missouri Association of Counties is pushing for lawmakers to expand the services and resources available to treat mental illness. Through its Policing, Justice & Mental Health Steering Committee, it says the increasing number of people with behavioral issues is overwhelming the courts, public administrators who are guardians of last resort and jails.The backlog of detainees waiting for treatment is a symptom of the larger community problems of mental health, the committee states in a 14-page discussion of the issue delivered to lawmakers earlier this year.“Individuals with mental health challenges and substance use issues can be found in every system that touches the justice system, from law enforcement to community-based placement options,” the report states.The jail-based program’s plan is to treat 80 detainees each year in jails or while released on bond with a goal of reducing the backlog to 25 or fewer waiting for treatment. To make space in hospitals and speed that process, it will combine residential facilities in Sikeston and Poplar Bluff, currently serving people with severe developmental disabilities and use one as a pre-release center for mental health patients on long-term commitments, Huhn said.That will free beds in existing facilities, she said. The people transferred in will be ready for release but without an appropriate placement ready to receive them, she said.In a budget hearing, Huhn said she was pleased at how eager lawmakers were to get the jail-based program in their communities during a public hearing on the statutory bill needed to allow the program. Current law requires the department to provide court-ordered treatments in its facilities.Akin said he’s ready to designate a section of his jail as a treatment center, and accept detainees from smaller counties in northwest Missouri as a regional hub.“I’m willing to try something different,” Akin said. “Because what we’re doing, what we’re working with right now, is not the best way.”This story was originally published by the Missouri Independent, part of States Newsroom.

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Poll: Support for Missouri abortion rights amendment growing

Published

8 months ago

August 29, 2024

Natural Bridge

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A proposed constitutional amendment legalizing abortion in Missouri received support from more than half of respondents in a new poll from St. Louis University and YouGov.That’s a boost from a poll earlier this year, which could mean what’s known as Amendment 3 is in a solid position to pass in November.SLU/YouGov’s poll of 900 likely Missouri voters from Aug. 8-16 found that 52% of respondents would vote for Amendment 3, which would place constitutional protections for abortion up to fetal viability. Thirty-four percent would vote against the measure, while 14% aren’t sure.By comparison, the SLU/YouGov poll from February found that 44% of voters would back the abortion legalization amendment.St. Louis University political science professor Steven Rogers said 32% of Republicans and 53% of independents would vote for the amendment. That’s in addition to nearly 80% of Democratic respondents who would approve the measure. In the previous poll, 24% of Republicans supported the amendment.Rogers noted that neither Amendment 3 nor a separate ballot item raising the state’s minimum wage is helping Democratic candidates. GOP contenders for U.S. Senate, governor, lieutenant governor, treasurer and secretary of state all hold comfortable leads.“We are seeing this kind of crossover voting, a little bit, where there are voters who are basically saying, ‘I am going to the polls and I’m going to support a Republican candidate, but I’m also going to go to the polls and then I’m also going to try to expand abortion access and then raise the minimum wage,’” Rogers said.Republican gubernatorial nominee Mike Kehoe has a 51%-41% lead over Democrat Crystal Quade. And U.S. Sen. Josh Hawley is leading Democrat Lucas Kunce by 53% to 42%. Some GOP candidates for attorney general, secretary of state and treasurer have even larger leads over their Democratic rivals.

Brian Munoz

St. Louis Public RadioHundreds of demonstrators pack into a parking lot at Planned Parenthood of St. Louis and Southwest Missouri on June 24, 2022, during a demonstration following the Supreme Court’s reversal of a case that guaranteed the constitutional right to an abortion.

One of the biggest challenges for foes of Amendment 3 could be financial.Typically, Missouri ballot initiatives with well-funded and well-organized campaigns have a better chance of passing — especially if the opposition is underfunded and disorganized. Since the end of July, the campaign committee formed to pass Amendment 3 received more than $3 million in donations of $5,000 or more.That money could be used for television advertisements to improve the proposal’s standing further, Rogers said, as well as point out that Missouri’s current abortion ban doesn’t allow the procedure in the case of rape or incest.“Meanwhile, the anti side won’t have those resources to kind of try to make that counter argument as strongly, and they don’t have public opinion as strongly on their side,” Rogers said.There is precedent of a well-funded initiative almost failing due to opposition from socially conservative voters.In 2006, a measure providing constitutional protections for embryonic stem cell research nearly failed — even though a campaign committee aimed at passing it had a commanding financial advantage.Former state Sen. Bob Onder was part of the opposition campaign to that measure. He said earlier this month it is possible to create a similar dynamic in 2024 against Amendment 3, if social conservatives who oppose abortion rights can band together.“This is not about reproductive rights or care for miscarriages or IVF or anything else,” said Onder, the GOP nominee for Missouri’s 3rd Congressional District seat. “Missourians will learn that out-of-state special interests and dark money from out of state is lying to them and they will reject this amendment.”Quade said earlier this month that Missourians of all political ideologies are ready to roll back the state’s abortion ban.“Regardless of political party, we hear from folks who are tired of politicians being in their doctor’s offices,” Quade said. “They want politicians to mind their own business. So this is going to excite folks all across the political spectrum.”

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Democrat Mark Osmack makes his case for Missouri treasurer

Published

8 months ago

August 29, 2024

Natural Bridge

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Mark Osmack has been out of the electoral fray for awhile, but he never completely abandoned his passion for Missouri politics.Osmack, a Valley Park native and U.S. Army veteran, previously ran for Missouri’s 2nd Congressional District seat and for state Senate. Now he’s the Democratic nominee for state treasurer after receiving a phone call from Missouri Democratic Party Chairman Russ Carnahan asking him to run.“There’s a lot of decision making and processing and evaluation that goes into it, which is something I am very passionate and interested in,” Osmack said this week on an episode of Politically Speaking.Osmack is squaring off against state Treasurer Vivek Malek, who was able to easily win a crowded GOP primary against several veteran lawmakers including House Budget Chairman Cody Smith and state Sen. Andrew Koenig.While Malek was able to attract big donations to his political action committee and pour his own money into the campaign, Osmack isn’t worried that he won’t be able to compete in November. Since Malek was appointed to his post, Osmack contends he hasn’t proven that he’s a formidable opponent in a general election.“His actions and his decision making so far in his roughly two year tenure in that office have been questionable,” Osmack said.Among other things, Osmack was critical of Malek for placing unclaimed property notices on video gaming machines which are usually found in gas stations or convenience stores. The legality of the machines has been questioned for some time.As Malek explained on his own episode of Politically Speaking, he wanted to make sure the unclaimed property program was as widely advertised as possible. But he acknowledged it was a mistake to put the decals close to the machines and ultimately decided to remove them.Osmack said: “This doesn’t even pass the common sense sniff test of, ‘Hey, should I put state stickers claiming you might have a billion dollars on a gambling machine that is not registered with the state of Missouri?’ If we’re gonna give kudos for him acknowledging the wrong thing, it never should have been done in the first place.”Osmack’s platform includes supporting programs providing school meals using Missouri agriculture products and making child care more accessible for the working class.He said the fact that Missouri has such a large surplus shows that it’s possible to create programs to make child care within reach for parents.“It is quite audacious for [Republicans] to brag about $8 billion, with a B, dollars in state surplus, while we offer next to no social services to include pre-K, daycare, or child care,” Osmack said.Here’s are some other topics Osmack discussed on the show:How he would handle managing the state’s pension systems and approving low-income housing tax credits. The state treasurer’s office is on boards overseeing both of those programs.Malek’s decision to cut off investments from Chinese companies. Osmack said that Missouri needs to be cautious about abandoning China as a business partner, especially since they’re a major consumer of the state’s agriculture products. “There’s a way to make this work where we are not supporting communist nations to the detriment of the United States or our allies, while also maintaining strong economic ties that benefit Missouri farmers,” he said.What it was like to witness the skirmish at the Missouri State Fair between U.S. Sen. Josh Hawley and Democratic challenger Lucas Kunce.Whether Kunce can get the support of influential groups like the Democratic Senatorial Campaign Committee, which often channels money and staff to states with competitive Senate elections.

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As Illinois receives praise for its cannabis equity efforts, stakeholders work on system’s flaws

Published

8 months ago

August 29, 2024

Natural Bridge

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Medical marijuana patients can now purchase cannabis grown by small businesses as part of their allotment, Illinois’ top cannabis regulator said, but smaller, newly licensed cannabis growers are still seeking greater access to the state’s medical marijuana customers.Illinois legalized medicinal marijuana beginning in 2014, then legalized it for recreational use in 2020. While the 2020 law legalized cannabis use for any adult age 21 or older, it did not expand licensing for medical dispensaries.Patients can purchase marijuana as part of the medical cannabis program at dual-purpose dispensaries, which are licensed to serve both medical and recreational customers. But dual-purpose dispensaries are greatly outnumbered by dispensaries only licensed to sell recreationally, and there are no medical-only dispensaries in the state.As another part of the adult-use legalization law, lawmakers created a “craft grow” license category that was designed to give more opportunities to Illinoisans hoping to legally grow and sell marijuana. The smaller-scale grow operations were part of the 2020 law’s efforts to diversify the cannabis industry in Illinois.Prior to that, all cultivation centers in Illinois were large-scale operations dominated by large multi-state operators. The existing cultivators, mostly in operation since 2014, were allowed to grow recreational cannabis beginning in 2019.Until recently, dual-purpose dispensaries have been unsure as to whether craft-grown products, made by social equity licensees — those who have lived in a disproportionately impacted area or have been historically impacted by the war on drugs — can be sold medicinally as part of a patient’s medical allotment.Erin Johnson, the state’s cannabis regulation oversight officer, told Capitol News Illinois last month that her office has “been telling dispensaries, as they have been asking us” they can now sell craft-grown products to medical patients.“There was just a track and trace issue on our end, but never anything statutorily,” she said.

Dilpreet Raju

Capitol News IllinoisThe graphic shows how cannabis grown in Illinois gets from cultivation centers to customers.

No notice has been posted, but Johnson’s verbal guidance comes almost two years after the first craft grow business went online in Illinois.It allows roughly 150,000 medical patients, who dispensary owners say are the most consistent purchasers of marijuana, to buy products made by social equity businesses without paying recreational taxes. However — even as more dispensaries open — the number available to medical patients has not increased since 2018, something the Cannabis Regulation Oversight Office “desperately” wants to see changed. Johnson said Illinois is a limited license state, meaning “there are caps on everything” to help control the relatively new market.Berwyn Thompkins, who operates two cannabis businesses, said the rules limited options for patients and small businesses.“It’s about access,” Thompkins said. “Why wouldn’t we want all the patients — which the (adult-use) program was initially built around — why wouldn’t we want them to have access? They should have access to any dispensary.”Customers with a medical marijuana card pay a 1% tax on all marijuana products, whereas recreational customers pay retail taxes between roughly 20 and 40% on a given cannabis product, when accounting for local taxes.While Illinois has received praise for its equity-focused cannabis law, including through an independent study that showed more people of color own cannabis licenses than in any other state, some industry operators say they’ve experienced many unnecessary hurdles getting their businesses up and running.The state, in fact, announced last month that it had opened its 100th social equity dispensary.But Steve Olson, purchasing manager at a pair of dispensaries (including one dual-purpose dispensary) near Rockford, said small specialty license holders have been left in the lurch since the first craft grower opened in October 2022.“You would think that this would be something they’re (the government) trying to help out these social equity companies with, but they’re putting handcuffs on them in so many different spots,” he said. “One of them being this medical thing.”Olson said he contacted state agencies, including the Department of Financial and Professional Regulation, months ago about whether craft products can be sold to medical patients at their retail tax rate, but only heard one response: “They all say it was an oversight.”This potentially hurt social equity companies because they sell wholesale to dispensaries and may have been missing out on a consistent customer base through those medical dispensaries.Olson said the state’s attempts to provide licensees with a path to a successful business over the years, such as with corrective lotteries that granted more social equity licenses, have come up short.“It’s like they almost set up the social equity thing to fail so the big guys could come in and swoop up all these licenses,” Olson said. “I hate to feel like that but, if you look at it, it’s pretty black and white.”Olson said craft companies benefit from any type of retail sale.“If we sell it to medical patients or not, it’s a matter of, ‘Are we collecting the proper taxes?’ That’s all it is,” he said.State revenue from cannabis taxes, licensing costs and other fees goes into the Cannabis Regulation Fund, which is used to fund a host of programs, including cannabis offense expungement, the general revenue fund, and the R3 campaign aiming to uplift disinvested communities.For fiscal year 2024, nearly $256 million was paid out from Cannabis Regulation Fund for related initiatives, which includes almost $89 million transferred to the state’s general revenue fund and more than $20 million distributed to local governments, according to the Illinois Department of Revenue.Medical access still limitedThe state’s 55 medical dispensaries that predate the 2020 legalization law, mostly owned by publicly traded multistate operators that had been operating in Illinois since 2014 under the state’s medical marijuana program, were automatically granted a right to licenses to sell recreationally in January 2020. That gave them a dual-purpose license that no new entrants into the market can receive under current law.Since expanding their clientele in 2020, Illinois dispensaries have sold more than $6 billion worth of cannabis products through recreational transactions alone.Nearly two-thirds of dispensaries licensed to sell to medical patients are in the northeast counties of Cook, DuPage, Kane, Lake and Will. Dual-purpose dispensaries only represent about 20 percent of the state’s dispensaries.While the state began offering recreational dispensary licenses since the adult-use legalization law passed, it has not granted a new medical dispensary license since 2018. That has allowed the established players to continue to corner the market on the state’s nearly 150,000 medical marijuana patients.But social equity licensees and advocates say there are more ways to level the playing field, including expanding access to medical sales.Johnson, who became the state’s top cannabis regulator in late 2022, expressed hope for movement during the fall veto session on House Bill 2911, which would expand medical access to all Illinois dispensaries.“We would like every single dispensary in Illinois to be able to serve medical patients,” Johnson said. “It’s something that medical patients have been asking for, for years.”Johnson said the bill would benefit patients and small businesses.“It’s something we desperately want to happen as a state system, because we want to make sure that medical patients are able to easily access what they need,” she said. “We also think it’s good for our social equity dispensaries, as they’re opening, to be able to serve medical patients.”Rep. Bob Morgan, D-Deerfield, who was the first statewide project coordinator for Illinois’ medical cannabis program prior to joining the legislature, wrote in an email to Capitol News Illinois that the state needs to be doing more for its patients.“Illinois is failing the state’s 150,000 medical cannabis patients with debilitating conditions. Too many are still denied the patient protections they deserve, including access to their medicine,” Morgan wrote, adding he would continue to work with stakeholders on further legislation.Capitol News Illinois is a nonprofit, nonpartisan news service covering state government. It is distributed to hundreds of newspapers, radio and TV stations statewide. It is funded primarily by the Illinois Press Foundation and the Robert R. McCormick Foundation, along with major contributions from the Illinois Broadcasters Foundation and Southern Illinois Editorial Association.

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