DDS turns COFAR’s public records request over to a computer, resulting in an initial processing fee estimate of over $22k
The Department of Developmental Services (DDS) has begun using computers and algorithms to locate and process records in response to our public records requests, and that doesn’t appear to have been a good thing for transparency.
In the latest case, I had asked DDS in January for records listing reasons for the closures of seven state-operated group homes during a two-year period from 2021 through this year.
You would think it would not be difficult for DDS to locate and provide a reasonably reviewable number of documents listing those reasons.
But in a response to my records request, a DDS attorney said the Department had “requested information technology (‘IT’) staff” to search for internal emails, and that the computer search had identified 33,541 such emails and attachments “that may be responsive.”
The DDS records attorney then noted that the Public Records Law allows agencies to charge $25 per hour for staff time in compiling and redacting documents in order to comply with privacy and other laws such as HIPAA.
The attorney stated that because it would take an estimated 837 hours to process the 33,500 emails, the fee for providing them to us would be $22,925. And that fee could go higher if the hourly estimate turned out to be low.
DDS supposed to use its “knowledge of the records”
Arguing that DDS could have located a small number of responsive records, I appealed the DDS response on January 23 to Manza Arthur, the state’s public records supervisor, who heads a division in the office of Secretary of the Commonwealth Bill Galvin. The Public Records Division was established to ensure that state agencies comply with the Public Records Law.
Arthur issued an initial “determination” on February 3 that DDS needed to explain more fully how it had calculated its fee. In addition, the supervisor stated that DDS must “must use its knowledge of the records to facilitate providing any responsive records.”
Arthur didn’t elaborate on what is involved in using knowledge in providing records. But to us, it seems to mean that DDS presumably has personnel who have knowledge of the issues involved, and that those individuals should be able to use that knowledge to find and produce a small number of responsive records.
In that case, there wouldn’t be a need to redact and process thousands of documents that may or may not be responsive to our records request.
A Guide to the Massachusetts Public Records Law published by CommonWealth magazine states, in fact, that a state agency’s “records custodian is required to use his or her ‘superior knowledge’ to determine the exact records that are responsive to (a public records) request.”
The use of such knowledge appears to be what was missing from the Department’s response to my records request. DDS appeared to have simply conducted a computer search for the records using search terms. Anyone can feed search terms into a computer. Institutional knowledge is much different.
DDS says it lacks “capacity,” apparently for a records search based on knowledge
In a phone conversation with the DDS records attorney on February 8, I suggested that instead of conducting a computer search for the records I was seeking, DDS should query departmental personnel with that knowledge of the issue and the records. I also offered to narrow my original request for documents to a period of four months between August and November 2021.
But in a February 17 written response to me, the DDS attorney stated that DDS “does not have the capacity to conduct searches for the documents responsive to your request.” Therefore, he said, DDS had once again requested It staff to conduct a computer search.
This time, the number of “potentially responsive documents” was narrowed to 2,399 emails. The attorney said that using an “algorithm for computing costs…,” DDS had calculated a new fee for producing records of $1,499.38.
While this estimated fee was down from DDS’s original fee estimate of $20,925, the revised estimate is still unacceptable to us. The DDS attorney didn’t elaborate on what he meant by lacking “capacity.” But the end result was the same as the first time. The Department was continuing to feed search terms into a computer.
A test for the state’s Public Records Division
As a result, on February 21, I once again appealed to the supervisor of records.
In my second appeal, I stated that using computers and algorithms to respond to public records requests — which DDS has now done on several occasions — invariably results in a large number of “potentially responsive” documents, which may or may not be truly responsive. Such computer searches also result in inordinately large processing fees for producing the records.
As noted, my narrowed records request concerned seven DDS-run group homes that were closed during the period from August through November 2021.
Does DDS lack such superior knowledge of records concerning those seven homes? Are there no employees within the Department who have an understanding of the reason or reasons that the homes, which the Department managed, were closed in that short period of time?
Is that what the Department means by lacking capacity? If there are no such knowledgeable employees in DDS, the Department should state that to be the case.
In my latest appeal, I asked the public records supervisor to order DDS to more fully explain what it means in saying the Department lacks the capacity to conduct anything other than a computer search for responsive records, and specifically why the Department cannot use its superior knowledge in searching for the requested records.
In our view, this is a potentially important test for the state’s Public Records Division.
Will the public records supervisor require DDS to query its employees about these records, which is something DDS apprently doesn’t want to do? Or will the supervisor find that doing a computer search is sufficient to constitute a use of institutional knowledge?
In that latter case, it would seem that DDS and other agencies would have the green light to turn every public records request entirely over to computer searches.
It’s certainly possible that the supervisor will come up with a different solution to the problem. We expect a determination from the supervisor next week.
UPDATE: DDS says it will hold provider ‘accountable’ for ‘unacceptable’ insect infestation in Waltham group home
A Department of Developmental Services (DDS) official said this week that the Department intends to hold the corporate provider that operates a group home in Waltham “accountable” for a cockroach infestation that has led to the temporary shutdown of the residence.
As we reported on Wednesday, five residents of the group home for persons with intellectual and developmental disabilities were evacuated from the residence last week due to the insect infestation. The residents have been staying at the Marriott Hotel in Woburn since the group home was shut on February 8, according to Christine Davidson, the mother of John Davidson, one of the residents.
The group home is run by WCI, Inc., a provider to DDS. As we reported, Christine has previously raised concerns about what she contends are unhygienic conditions in the residence.
In an email sent on Wednesday afternoon to both Christine and her nephew George Papastrat, who are John’s co-guardians, Jessica Belcher, assistant DDS area director, said she “just wanted to follow up with you about the recent concerns in regard to the cockroach infestation at WCI’s Kendall Park home.”
Belcher stated that, “We agree that this is completely unacceptable and are holding the agency (WCI) accountable to fix the problem and create a plan so that something like this does not happen again.” She didn’t elaborate on what steps DDS is taking to hold WCI accountable.
Belcher aded that, “We understand that this interruption in John’s life is problematic, and we will work collaboratively with you both so that the disruption causes the least amount of stress possible for John.”
Christine said she is glad to receive a message of concern from DDS, but is still having difficulty in getting answers to her questions about situation. She said she has tried for the past two days to reach a top manager at WCI, but he hasn’t called her back. She said she still has not gotten any word as to when the group home will reopen.
Christine also said that among her concerns is that John has not had access for the past week to a breathing machine for treating his sleep apnea. His previous machine was infested by the cockroaches and was reportedly disposed of by the group home.
The email message from Belcher came on Wednesday, a week after the residence was shut down and just hours after our blog post about the matter was published.
In her message, Belcher told Christine and George to “let us know if you feel a meeting between yourselves and DDS is needed at this time.” Christine said she responded by asking Belcher to contact her. She said she hasn’t yet received a response from Belcher.
Belcher also stated in the Wednesday email that DDS “would also like to encourage you to call DPPC (the Disabled Persons Protection Commission) to report any additional concerns that may arise.”
It is unclear whether the group home was ordered shut after an inspection by DDS. The Department conducts licensure inspections of both provider-run and state-run group homes.
I sent an email Tuesday morning to DDS Commissioner Jane Ryder, asking whether the Department had any comment on the shutdown of the home, and whether the shutdown is an isolated incident. Ryder has not yet responded to my message.
We are glad as well that DDS has indicated concern about the situation to Christine and George. But we too would like to see the Department and WCI do more to keep Christine and the other families and guardians of the group home residents informed. There is no excuse for not returning their phone calls.
Waltham group home reportedly temporarily shut down due to insect infestation
Five residents of a group home in Waltham for persons with intellectual and developmental disabilities were evacuated from the residence last week after it was ordered shut down due to an insect infestation, according to the mother of one of the residents.
Christine Davidson, whose son John is a resident of the home, which is run by WCI, Inc., a corporate provider to the Department of Developmental Services (DDS), said her son and the other residents have been temporarily moved into the Marriott Hotel in Woburn. She said it has been difficult to get information about the situation, and no one has told her when the group home will reopen.
Christine has previously raised concerns about what she contends are unhygienic conditions in the residence.
The insects appear to be cockroaches, based on a photo taken by Christine of her son’s BiPAP breathing machine, which appears to have two roaches inside it. Christine said that when John came home to her house over the weekend, she saw bugs in his breathing machine, and said two bugs crawled out of his wheelchair. BiPAP and CPAP machines are used to treat sleep apnea.
A portion of John’s breathing machine, which appears to contain two cockroaches. (Photo taken by Christine Davidson.)
It is unclear whether the group home was ordered shut after an inspection by DDS. The Department conducts licensure inspections of both provider-run and state-run group homes.
I sent an email Tuesday morning to DDS Commissioner Jane Ryder, asking whether the Department had any comment on the shutdown of the home, and whether the shutdown is an isolated incident. Ryder has not yet responded to my message.
Christine said the residents are being fed meals in their rooms in the hotel. She said John has been taken on a daily basis to his day program in Medford since his move to the hotel, but has few other activities while he is in his hotel room.
She said she is concerned her son’s health may be at risk as a result of the infestation. “Right now, he (John) doesn’t have a breathing machine,” she said. “It’s a dangerous situation.” She said the group home took back his contaminated machine.
Christine said she believes John could have picked up a pulmonary infection by using a machine that was infested with roaches. She said she has made several calls to her son’s DDS service coordinator and the coordinator’s supervisor hoping to relay her concerns and get answers to her questions, but no one has called her back.
Christine has previously raised concerns about unsanitary conditions at the Waltham group home, including the allegedly unhygienic state of John’s BiPAP breathing mask. On February 3, 2022, Steven Cohen, a gastroenterologist with Beth Israel Deaconess Medical Center, also stated in a medical progress note that John’s breathing mask at that time was “apparently not hygienic.”
Also last February, Christine sent us photos of potentially unsanitary conditions inside the group home, including a clogged air vent, a dirty bathroom, and what appeared to be insect larvae on John’s clothing in his bedroom dresser drawer. At the time, we were not able to confirm that the objects on his clothing were actually larvae.
Christine said that despite her complaints, the unhygienic conditions in the group home have persisted over the past year. It is unclear why those issues have lingered until they apparently triggered a shutdown of the residence.
We are receiving more frequent reports of a lack of activities and proper care of residents in group homes around the state. These reports appear to stem, at least in part, from an ongoing staffing shortage since the COVID pandemic began.
DDS upholds disenrollment of client from shared living, but appears to leave door open for her to reapply
Department of Developmental Services (DDS) Commissioner Jane Ryder last week upheld the Department’s move last summer to disenroll Mercy Mezzanotti, a DDS client, from shared living services because Mercy has refused to move out of the home of her longtime caregiver, Karen Faiola.
However, in accepting a hearing officer’s 10-page decision in the matter, Ryder appeared to leave the door open for Mercy and Karen to reapply directly to a “qualified provider” agency in order to continue their shared living relationship.
DDS does not directly employ shared living caregivers such as Karen, but funds nonprofit “qualified providers” that do directly contract with them.
In an interview last week, Mercy said DDS officials had repeatedly told her that she would have to leave Karen’s home and find another caregiver in order to continue receiving shared living services. But Johanna Soris, the hearing officer, stated in her decision that it is the responsibility of the qualified provider agency, and not DDS, to determine whether to employ a particular caregiver and whether to accept a client into its program.
Karen Faiola and Mercy Mezzanotti
As we have reported, the previous qualified provider in the case, Venture Community Services, temporarily removed Mercy, against her will, from Karen’s Sutton home last May, and placed Mercy in the home of another person in Worcester whom Mercy had never met. That same day, May 23, Venture terminated Karen’s shared living contract without stating a reason for the termination.
Karen and Mercy maintain that Venture terminated Karen’s contract because the two of them had complained that Venture employees had emotionally abused Mercy.
After objecting to her involuntary move, Mercy was able to return, after two days, to Karen’s home. However, DDS notified Mercy in July that she was no longer eligible for enrollment in the Department’s Home and Community Based Services (HCBS) Intensive Support Waiver Program, which funds shared living services.
Mercy appealed her disenrollment, and a “fair hearing” was held on her appeal on November 10. Soris was appointed as hearing officer in the case by Commissioner Ryder.
DDS argued during the hearing that Mercy became ineligible for the HCBS Waiver program when she came back to live with Karen after her involuntary removal from Karen’s home.
According to DDS’s argument, which was presented in a legal brief in the case, shared living services must be provided by a caregiver who is employed by a qualified provider. The Department maintained that because Karen was no longer under contract with Venture, she could no longer provide shared living services under the HCBS Waiver program. And because Mercy had refused to leave Karen, DDS argued that Mercy herself was no longer eligible for the program.
DDS said to have no role in hiring shared living caregivers
Karen, who has continued to care for Mercy in her home, said she contacted a new qualified provider agency, but was told by that agency that DDS would have to refer her to them in order for her to continue to provide shared living services. She said DDS has refused to provide such a referral. As a result, she has not been paid for providing services to Mercy since May.
In her decision, Soris, the hearing officer, asserted that DDS has no authority under the Waiver program to refer Karen to another qualified provider because DDS does not contract directly with caregivers. According to the decision, the shared living process requires both Mercy and Karen to apply directly to qualified providers to participate as a client and caregiver respectively.
In our view, Soris’s decision, while upholding Mercy’s disenrollment from the Waiver program, implies that both Mercy and Karen could apply to any qualified provider of their choosing and ask that they be allowed to remain together. Karen said last week that she and Mercy plan to do that.
Soris’s decision added that, “The Appellant (Mercy) is still entitled to Waiver services so long as she fills out the proper paperwork and works with a DDS service coordinator to find a Qualified Provider.” In our view, it isn’t clear, based on Soris’s other findings, why Mercy would even need to work with a DDS service coordinator in that regard. Soris appears to have concluded that DDS plays no role in the shared living application process, either with regard to the client or the caregiver.
Hearing officer notes that Mercy benefited from Karen’s care
In her decision, Soris’s acknowledged that Mercy had “thrived” under Karen’s care. And her decision provided details that appear to cooroborate Karen and Mercy’s claim that Venture terminated Karen’s contract after Karen and Mercy had both complained that Venture employees had emotionally abused Mercy.
Soris noted that prior to living with Karen, Mercy had lived in four different shared living homes “that were each unsatisfactory in different ways.”
Citing the testimony of both Mercy and of her therapist, Grishelda Hogan, Soris wrote that Mercy originally “came to Karen Faiola’s home as a shy, timid person who could not effectively advocate for herself. Over the course of the four years with Karen Faiola, (Mercy) made great strides in overcoming her shyness and gaining self-confidence,” Soris added.
Soris also noted testimony from both Mercy and her therapist that that Mercy was having “difficulties” with her job coach, who was a Venture employee, and that Karen had asked Venture management on numerous occasions to have the job coach replaced. Mercy maintained that the job coach was emotionally abusive toward her.
Soris then stated that on May 19, Venture convened a Zoom meeting in which Karen “was informed she should resign and Venture employees would be removing (Mercy from Karen’s) home on May 23.” No reason was noted in Soris’s decision for Venture’s decision to terminate Karen.
Mercy told staying with Karen was “not an option”
On May 20, Soris wrote, a behavioral counselor from Venture picked Mercy up at her work place and “instructed her to pack her belongings over the weekend because Venture was taking her to a new home for a new start.” Soris added that Mercy “didn’t know why she couldn’t continue living with Karen Faiola. (The Venture behavioral counselor) told her it was not an option. (Mercy) was crying and stunned at this information.”
Then on Monday, May 23, Soris stated, the Venture job coach picked Mercy up at her work place and dropped her off at the new shared living caregiver’s home. Mercy then spent two days there.
“During that time,” Soris stated, Mercy “phoned and texted Karen Faiola and Grishelda Hogan exhibiting great distress to the point that both women (Karen and Hogan) filed complaints with DPPC (the Disabled Persons Protection Commission) alleging that (Mercy) was experiencing great emotional distress.”
On May 25, after having spent two nights at the new shared living caregiver’s home, Mercy called Karen “and asked her to bring her home,” Soris stated. “Karen Faiola did so and described (Mercy) as a ‘happy camper’ (in returning to her home.)”
As noted, we asked DPPC last fall to undertake a full investigation of the allegations of emotional abuse by the job coach and of Mercy’s involuntary removal from Karen’s home. DPPC has not responded to our request.
DPPC apparently referred the complaints filed by Karen and Hogan to DDS. A September 30 Complaint Resolution letter written by DDS Area Director Denise Healy did not assess whether the alleged actions of the Venture employees were appropriate, or indicate that the allegations of emotional abuse had been investigated.
We are hoping for a happy outcome to this continuing ordeal for both Mercy and Karen. Mercy said the fact that Karen hasn’t been paid since last May to care for her has had a severe financial impact on both of them. “I’m having sleepless nights,” she said. “We could end up homeless.”
Continuing drop in number of residents threatens continued existence of DDS state-run facilities
New data that COFAR has received from the Department of Developmental Services (DDS) shows the number of residents or the census at both the Wrentham Developmental Center and Hogan Regional Center continued to drop from Fiscal Years 2019 through 2022.
The data, which was provided by DDS last week under a Public Records Law request, shows that as of Fiscal Year 2022, the census at the Wrentham Center was 182, down from a high of 323 in Fiscal 2013 — a 44% drop. The census at Hogan was down to 95 in 2022, from a high of 159 in 2011. That is a drop of 40%.
Previous data from DDS showed that the total census in the state-operated group homes declined from a high of 1,206 in Fiscal 2015, to 1,097 in 2021 — a 9% drop.
Meanwhile, the census in the state’s much larger network of privatized group homes has continued to climb, rising from 6,677 to 8,290 between 2008 and 2021 — a 24% increase. (See the graphs below.)
Hogan now has well under 100 residents remaining, and Wrentham is well under 200. Since August 2021, DDS has closed seven state-operated group homes and subsequently reopened one.
But more troubling than those closures is the fact that DDS does not inform individuals and families seeking residential placements that these state-run facilities even exist. Last fall, we wrote about a rare admission to the Wrentham Center, but that appears to have been the exception. We have heard from several people who have been unsuccessful in seeking placements for their loved ones in either ICFs or state-operated group homes.
That policy decision by DDS to discourage or block new admissions guarantees that the number of residents in state-run residential care will continue to drop, and that the ICF’s, in particular, will eventually be closed.
Source: DDS
DDS says it has no records on plans to close Wrentham or Hogan
Despite the continuing downward trend in the census at Wrentham and Hogan, DDS said in response last week to our Public Records request that they have no records concerning projections or plans to close those facilities. We have appealed that response to the state supervisor of public records, arguing that the Department did not indicate that it had done a search for such internal plans or projections.
Given the declining census at both Hogan and Wrentham, we believe it is unlikely that there are no departmental emails or other records at least discussing the possibility that these facilities will eventually close.
ICFs and state-operated group homes are vital backstops for care
State-run residential facilities are vital to the fabric of care in the DDS system. As Olmstead v. L.C., the landmark 1999 U.S. Supreme Court decision, recognized, there is a segment of the population with I/DD that cannot benefit from and does not desire community-based care. ICFs, in particular, must meet stringent federal standards for care that make them uniquely appropriate settings for persons with the most profound levels of disability and medical issues.
The ever-expanding network of group homes in Massachusetts that are run by corporate providers that contract with DDS have become bottom-line operations that meet minimal standards for direct-care pay and training. Abuse and neglect are rampant problems in the group home system. Meanwhile, the executives running these provider organizations have seen their salaries skyrocket in recent years.
As funding for the ICFs and state-operated group homes has declined or remained stagnant respectively over the past decade, funding for the corporate-run group home system has grown steadily to over $1.4 billion today.
Allowing the state-run network of care in Massachusetts to wither and die through underfunding and attrition will lead to a catastrophic decline in the level of care and services for some of our most vulnerable residents.
Seven years after the closure of his sheltered workshop, Mark Garrity is still waiting for something to replace it
It has always been his work that has motivated Mark Garrity, his sister Patty says.
When he participated in his sheltered workshop, Mark was productive and social. He derived meaning from the tasks he was given, and he had fun with his friends.
Mark, 52, who has an intellectual disability, doesn’t need or care about being paid a minimum wage for it, Patty says. What is important to him is completing an assigned task.
“If Mark sees a pen without a cap, he’ll put it on with a twist and be proud of it,” Patty says.
But since 2016, when all remaining sheltered workshops were closed in Massachusetts, Mark has faced a void as far as work is concerned.
Mark Garrity (lower right) at a fundraiser for Road to Responsibility with his mother Helen (lower left). In upper row is Mark’s sister Marybeth Garrity (left), his sister Patty Garrity, and John Gregory, a staff member at the time in Mark’s group home.
Mark’s community-based day program is run by the Road to Responsibility (RTR), a provider to the Department of Developmental Services (DDS). The day program offers a cooking class in the kitchen, but that doesn’t interest Mark.
“He just stays in one room where he eats lunch,” Patty says. “When they took away his workshop, they took away his meaning. He’s not like you and me.”
Can’t function in the community
In his sheltered workshop, Mark packaged and assembled things such as car door locks. He took pride in that work.
The purpose in closing the workshops, according to the successive administrations of then Governors Deval Patrick and Charlie Baker, was to place people with intellectual and developmental disabilities in mainstream or integrated work settings that pay at least minimum wage. But Patty says that approach doesn’t work for Mark.
“He can’t produce at the minimum wage level,” she said. And now with the minimum wage in Massachusetts having risen to $15 an hour, she says, it would be even more difficult to find a suitable job for Mark in the community.
Moreover, if Mark were to go off-site and into the community to work, he would need 1-to-1 staffing assistance, Patty said. His day program doesn’t have sufficient staffing for that.
A few years ago, Patty proposed to Mark’s day program staff that the clients be given objects to pack into gift bags that the clients could then deliver to homeless shelters. She said she was told, though, that the program didn’t have the funds to purchase the gift bag items.
“Now his work is long gone,” she said, “and we continue to wait, and nothing is showing up.”
Federal and state lawmakers need to be informed about the value of work activities
We need to let our state legislators and members of Congress know about the lack of meaningful work activities in day programs, which is not unique to Mark’s program.
In the just-ended session of Congress, every member of the Massachusetts delegation, with the exception of U.S. Rep. Richard Neal, co-sponsored legislation (H.R. 603 and S.53), which would eliminate remaining sheltered workshops throughout the country and require that all clients be paid minimum wages in “integrated” work settings. Fortunately, the bills were not approved in that session, but the legislation will no doubt be reintroduced.
You can find your members of Congress here and state legislators here. Please let them know that if they support the elimination of sheltered workshops, they need to find ways to replace the work the shelters provided, particularly for those persons who can’t function in the community.
Sheltered workshop closures left thousands with little to do
All sheltered workshop programs were closed in Massachusetts as of 2016 after the federal Department of Justice had stated two years earlier that developmentally disabled people should work in integrated employment settings in which a majority of the workers are not disabled.
But while sheltered workshops have been deemed “segregated” settings because they are offered solely to groups of developmentally disabled persons, many clients and their families and guardians argued that the programs provided fulfilling, skill-building activities and did not preclude community integration.
Ever since the closures of the workshops, thousands of DDS clients have been transferred to day programs with little or nothing to replace the work opportunities they previously had.
For a potentially significant number of DDS clients such as Mark, mainstream work settings have never been a viable option. Those persons aren’t able to function in those settings or don’t desire to do so.
Neurologist said sheltered workshop was important for Mark
While Mark has had an intellectual disability since birth, his cognitive functioning was further impaired when he suffered a traumatic brain injury after being hit by a car in 1995. In a letter written before Mark’s sheltered workshop program was ended, his neurologist, Dr. Douglas Katz, a member of the Department of Neurology at Boston Medical Center, stated in that Mark began a long course of rehabilitation after the accident, and that his sheltered workshop activities were an important part of that rehabilitation effort.
Katz added that, “I understand this (sheltered workshop) program is …likely to close… I think this would be a big loss for my patient Mark. I would support efforts to maintain this structured workshop for Mark and others that benefit from this service.”
Day program found a partial solution
In some cases, day programs have tried to find ad hoc solutions to the lack of available work activities. After COFAR contacted DDS about Mark’s situation in early 2017, RTR staff found a paper shredding activity for Mark to do at the day program site. The activity received verbal approval from the DDS southeast regional director, who determined that it was in compliance with federal regulations.
The paper shredding seemed at first to be a good solution for Mark. But Patty said that Mark soon sensed a lack of structure and purpose in the activity and became bored with it.
In 2016, we first urged state legislators to recognize that like Mark, not every DDS client is capable of or desires to participate in the mainstream workforce.
In 2019, we asked those lawmakers to support H.88, a bill which would have required that meaningful work activities be provided in DDS community-based day programs. But the language in the bill was subsequently removed by the Children, Families, and Persons with Deisabilities Committee and replaced with language establishing a Permanent Commission on the Status of Persons with Disabilities.
Day program staffing shortages have made problems worse
Day programs around the state are currently struggling with staffing shortages, which have made it even more difficult for them to provide meaningful activities to clients.
Mark’s day program is no exception. Mark, who stayed home from the program during the height of the COVID pandemic in 2020, is now back attending the program only one day per week due to the insufficient staffing.
Mark is still doing the paper shredding activity there, Patty says. But for most of the four-hours he spends at the day program site, “he’s mostly a spectator,” she said.
Patty herself takes Mark out of his group home on Mondays for coffee and errands. On Tuesdays and Thursdays, she takes him to the YMCA where he works with a personal trainer. On Wednesdays, after his day program ends, Patty takes him to a weekly bowling program. And on Fridays, Saturdays, and Sundays, she takes him out for coffee and to visit friends.
“As far as the community goes, Mark has a very balanced life,” she said. “It’s his work piece that is missing.”
Patty is planning to introduce Mark to her local legislators. She thinks that may help them to understand “what Mark can and cannot do.”
“I sometimes feel defeated,” Patty said, “I but will never give up the fight for Mark. “He’s capable of so much more, but the system needs to respond.”
Update: Problematic SDM bill dies at end of legislative session
A problematic bill that would have authorized Supported Decision Making (SDM) as a substitute for guardianships of persons with intellectual and developmental disabilities (I/DD), died at the end of the just-completed two-year session of the state Legislature on Tuesday.
The bill (S. 3132) had passed the Senate in November and was a step away from final passage in the House. However, the House Ways and Means Committee declined to advance it to a remaining “informal” session of the House where it could have been approved on a voice vote, without debate.
As we noted in our previous post, the bill lacked provisions to protect the rights of persons with I/DD and their families and guardians. Last month, we urged the staff of the Ways and Means Committee not to send the bill to the House for final passage.
The bill, which would replace guardianship of individuals with informal teams of “supporters,” will most likely be reintroduced in the new two-year legislative session, which began yesterday (Wednesday). Unfortunately, our guess is that the proponents of SDM will file the same piece of legislation that they have filed several times previously without including our suggestions to improve the bill.
Under the bill, SDM “supporters” would help individuals with I/DD make key life decisions, including decisions about their care and finances. Most people with I/DD currently have guardians, most of whom are family members of those individuals. But SDM proponents maintain that guardianship, even when guardians are family members, unduly restricts an individual’s right to make those decisions.
In our view, however, a key piece missing from the SDM legislation so far has been a standard for the level of I/DD under which an individual cannot reasonably be considered to be capable of making decisions even with “support” from clinicians, paid caregivers, and other SDM team members.
The SDM legislation assigns the role of the “decision maker” to the person with I/DD. The SDM bills submitted each legislative term thus far have drawn no distinction between people with the lowest cognitive levels and those with the highest functional levels of I/DD. As a result, we think the legislation presents a potential for financial exploitation of persons with I/DD.
In that regard, we pointed out to the committee that the bill needed a provision prohibiting providers from being involved as SDM “supporters” in helping individuals make “decisions” about services the providers offer.
As we noted, we think SDM is a concept that needs to go back to the drawing board. We would be happy to work this time around with legislators and SDM supporters in drafting a bill that contains the safeguards we’ve noted here and in our previous post.
SDM bill close to passage in Legislature, yet still lacks safeguards to protect individual and family rights
Legislation to establish Supported Decision Making (SDM) for persons with intellectual and developmental disabilities (I/DD) in Massachusetts has gotten close to final passage in the state Legislature.
But, as we’ve said about similar bills in the past, the current bill (S. 3132) lacks safeguards to protect the rights of individuals in the Department of Developmental Services (DDS) system and the rights of their family members and guardians.
The bill, which would replace guardianship of individuals with informal teams of “supporters,” passed the Senate in November, and is now in the House Ways and Means Committee. We have urged key legislators not to pass this bill during the remaining “informal” House session in which the bill would not even require debate or a recorded vote by individual members.
Under the legislation, the SDM supporters would help individuals with intellectual and developmental disabilities (I/DD) make key life decisions, including decisions about their care and finances. Most people with I/DD are currently under guardianship. But SDM proponents maintain that guardianship unduly restricts their right to make those decisions.
In our view, however, the bill continues to lack safeguards to protect individuals with I/DD from potential financial exploitation, and to prevent the marginalization of their family members in SDM arrangements. A key piece missing from the bill is a standard for the level of I/DD under which an individual cannot reasonably be considered to be capable of making decisions even with “support” from clinicians, paid caregivers, and other SDM team members.
We recently informed the House Ways and Means staff that a Syracuse Law Review article published earlier this year about SDM pilot projects in Massachusetts identifies, or at least implies, a number of problems or difficulties associated with SDM that are not addressed in the bill.
The lead author of the law review article is Cathy Costanzo, executive director of the Center for Public Representation (CPR), a Massachusetts-based nonprofit law firm that is one of SDM’s major supporters. The article is highly supportive of SDM as an alternative or replacement for guardianship. But among the issues or problems with SDM that the article raises or implies are the following:
Lack of a standard for decision-making ability
The law review article is not specific about the levels of I/DD among the SDM pilot project participants. It states that in a CPR-sponsored pilot project in Massachusetts, there were eight participants who “represented a cross-section of people with varying support needs and from a range of demographics.”
The article doesn’t say, however, whether any of these participants were non-verbal, for instance, or whether they were all capable of understanding the decisions they were making under the SDM model. Our concern has to do with the fact that SDM assigns the role of the “decision maker” to the person with I/DD. Neither the article nor S.3132 discuss whether there is a level of ID below which it is not possible for the participant to appreciate or understand the decisions they are supposedly making.
We hope legislators understand that there is a wide range among levels of intellectual disability (ID), and that those levels have different impacts on an individual’s ability to make decisions. For instance, as described by the American Psychiatric Association (APA), persons with severe and profound levels of ID have IQ levels of 35 or below. The average IQ score is 100.
According to the APA, persons with severe ID comprise about 3 to 4% of the total ID population. The APA notes that for those people, “communication skills are very basic,” and “self-care activities require daily assistance.”
Profound ID applies to 1 to 2% of the ID population who have IQs below 20. Those persons are “dependent upon others for all aspects of daily care, and “communication skills are quite limited.”
For people in those categories, we think the potential for informed decision making about key life decisions, even with support from others, is very low if not non-existent. Yet, S. 3132 makes no allowance for that. The bill draws no distinction between people with the lowest cognitive levels and those with the highest functional levels of I/DD.
As a Penn State Law Review article about SDM states:
…there is a potentially unavoidable paradox in acknowledging that a person has diminished decision-making capacity but maintaining that he or she is nevertheless capable of meaningfully contributing to decision-making discussions and that the decisions that result from such discussions reflect his or her wishes.
Given the diminished decision making capacity among persons with severe and profound levels of ID, we think those people are especially vulnerable to financial exploitation from persons on their support teams who may “help” them make financial decisions that don’t reflect their wishes. See our discussion below about the potential conflict of interest faced by support team members who are also employees of corporate providers that provide services to the disabled individuals.
In these situations, family members of persons with I/DD, whom we have found to be likely to act in the best interest of their loved ones, may find themselves outvoted on the support teams by other team members who stand to benefit financially from the clients’ “decisions.”
We think there is a greater potential for SDM to work effectively for people with what the APA describes as mild levels of ID. Mild ID, which comprises an IQ range of 50 to 70, includes about 85 percent of people with intellectual disabilities.
According to the APA, people with mild ID “are mostly self-sufficient with sufficient supports.” Those supports, the APA says, “might include assistance with life decisions.” So, it makes sense to assume that people with mild ID are capable of participating in a team discussion that would result in a decision of that magnitude.
A potentially more problematic group in terms of decision making ability are those persons with what the APA labels as moderate intellectual disability. People in this group, who have IQs ranging from 36 to 49, comprise about 10% of the ID population.
According to the APA, people with moderate ID need support for making “social decisions (particularly romantic decisions).” Independent living may be achieved for this group “with moderate supports such as those available in group homes.”
Once again, S. 3132 doesn’t make distinctions between any of these levels of ID. The bill assumes that all persons with I/DD, no matter how low their level of cognition is, are capable of making complex life decisions.
Conflicts of interest in SDM support teams
As previously noted, members of an individual’s SDM team who are also service providers to that person face a potential conflict of interest when they advise the “decision maker” about making use of the services they provide. The Syracuse Law Review article states that in the Massachusetts pilot project:
…project staff had frank discussions with the Decision Maker and supporters about any potential conflict of interest and how to draft an agreement to minimize the potential conflict, such as having paid supporters not assist with decision-making support for issues that concern services from the agency paying the supporter (my emphasis).
There is, however, no such restriction in S.3132 against providers being involved in decision-making regarding services they provide. We think the SDM legislation needs such a provision.
Need for public funding
The Syracuse Law Review article stated that one of the lessons of the Massachusetts and other pilot projects was that “without dedicated funding, ample cash reserves or an extraordinary commitment to Supported Decision Making, it is very difficult for organizations to introduce, implement and help to support Supported Decision Making for a large number of individuals.”
There is no reference in S.3132, however, to a potential funding mechanism for SDM in Massachusetts. At the same time, the law review article states that providing public funding for SDM could introduce other problems into the model by turning it into a paid service.
Lack of a dispute resolution process
The Syracuse Law Review article recognizes that there are likely to be disputes within SDM networks or teams, and noted that a pilot program in New York State created a “Mediation Module designed as a two-day training for mediators.” While S.3132 requires EOHHS to establish an SDM training program in Massachusetts, it doesn’t specify that the program should include training in dispute resolution.
In our experience, many disputes in the care of persons with I/DD occur between family members or guardians, on one hand, and DDS and providers, on the other. In other words, DDS tends to support the providers’ positions in these matters, and family members and guardians are often left in an isolated position. What may be needed is an independent mediation process for disputes that places family members on a level playing field with the other parties when disputes arise.
It’s interesting that many of our major concerns about SDM are either discussed or implied in the Syracuse Law Review article, which was written by major SDM proponents. The Legislature has yet to come up with a bill that addresses these problems. SDM is a concept that needs to go back to the drawing board in the coming legislative session.
DDS placing client in a ‘Catch-22’ position to force her to leave her shared living caregiver
The Department of Developmental Services is arguing in a legal brief that Mercy Mezzanotti, a departmental client, should be disenrolled from a program that provides her with shared living services unless she agrees to move away from her long-time caregiver, Karen Faiola.
But Mercy maintains that she wants to stay with Karen with whom she and her therapist say she has thrived emotionally over the past four years.
In May, Karen’s previous payment agency, Venture Community Services, suddenly canceled her shared living contract without stating a reason in its termination notice. As a result of the contract termination, DDS maintains in the legal brief that Karen is no longer a “qualified shared living provider.”
The DDS brief further argues that because Mercy has refused to move in with a new caregiver, she has “voluntarily declined” shared living services and should be disenrolled from the program.
For reasons that DDS has not revealed publicly, the Department has declined to refer Karen to a new shared living payment agency. DDS does not contract directly with shared living caregivers, but does refer them to shared living payment agencies such as Venture. Were DDS to refer Karen to a new agency, Karen would presumably become a qualfied caregiver once again.
Karen Faiola and Mercy Mezzanotti
Karen and Mercy both maintain that Karen’s contract was terminated after both of them accused Venture employees of emotionally abusing Mercy. They claim DDS is siding with Venture in the matter, and that the Department has refused to fully investigate their charges.
Because DDS has declined to refer Karen to a new corporate payment agency, Karen has not been paid since May for caring for Mercy even though Mercy has continued to reside in her home. In Karen’s and Mercy’s view, DDS’s legal argument has placed both of them in impossible, Catch-22 positions in order to deny what Mercy has expressly stated what she wants – services from Karen.
Mercy’s appeal of DDS’s disenrollment notice is now before a state hearing officer who held a hearing on it last month. By way of disclosure, I attended the November 10 hearing via Zoom and testified in support of Mercy and Karen. I agreed, at the request of hearing officer and Erin Brown, a DDS assistant general counsel, not to publish details of the actual hearing on this blogsite until the hearing officer renders her decision, which is expected sometime later this month.
As a result of that agreement, I am confining this post to a discussion of the legal brief filed by Brown with the hearing officer on December 7, after the hearing concluded. In her brief, Brown laid out the Department’s argument for disenrolling Mercy from services under the Home and Community Based Services (HCBS) federal waiver program.
In May, as we also reported, Venture employees removed Mercy, against her will, from Karen’s home and placed her for two days in the home of another caregiver whom she didn’t know. After objecting to the move, Mercy was able to return to Karen’s home. We have joined Mercy and Karen in asking the Disabled Persons Protection Commission (DPPC) to fully investigate both the removal of Mercy from Karen’s home and allegations made by Mercy that she had been previously emotionally abused by Venture employees.
Catch-22 positions for Mercy and Karen
The key point Brown makes in her brief is that Mercy became ineligible for the HCBS Waiver, which supports shared living, when Mercy came back to live with Karen after her involuntary removal from Karen’s home. Brown’s brief stated that Mercy:
…voluntarily declined shared living supports from a Qualified Provider, and instead choose to live with Ms. Faiola (Karen). This choice, which is her right, resulted in (Mercy) being ineligible for the (HCBS) Waiver because she was not receiving a Waiver program service: Ms. Faiola is not a qualified and licensed provider, nor is Ms. Faiola employed by a Qualified Provider to provide Waiver services.” (my emphasis)
However, as noted above, the reason Karen is not employed by a Qualified Provider is that Venture terminated her contract without stating a cause, and DDS will not refer her to a new Qualified Provider.
Also, while Brown stated that Karen herself is not a licensed or qualified shared living provider, Brown later stated in the same brief that in this case, the licensed and qualified provider was Venture, a DDS-funded corporate agency, that contracts directly with shared living caregivers. Shared living caregivers themselves, such as Karen, are not licensed by DDS.
DDS says psychotherapist’s testimony that Mercy has reportedly thrived under Karen’s care was irrelevant
In her brief, Brown acknowledged that Grishelda Hogan, an outpatient psychotherapist, who has treated Mercy since 2018, testified during the hearing that she has “not had any concerns about (Mercy) in the care of Ms. Faiola.”
As we reported, Hogan actually sent a written statement to the hearing officer prior to the hearing in which she stated that Mercy had “expressed consistently that she was happy in her home (with Karen)…It was clear in therapy that (Mercy) was making great strides in her life and I was able to see her self-esteem and self-worth develop as she finally felt seen and heard.“
Brown stated in her brief, however, that “the entirety of Ms. Hogan’s testimony was irrelevant. She did not testify about the (HCBS) Waiver or Waiver rules. There were no clinical matters at issue in the fair hearing, nor was Ms. Hogan qualified as an expert to speak on clinical matters.”
It appears that Brown is admitting in her brief that Mercy’s emotional state, and her wishes, are irrelevant to DDS. Also, Hogan is a psychotherapist who has worked with Mercy for four years. Brown’s brief offers no reason why she would not be qualified to speak on clinical matters.
Brown similarly contended in her brief that testimony by Mercy’s sister Tami Baxter that Mercy was doing well in Karen’s care was irrelevant. And Brown maintained that Karen’s testimony that DDS has refused to refer her to another qualified provider was “outside the scope of the fair hearing and irrelevant.”
In our view, Karen’s employment relationship with Venture is of central relevance to the case. Venture’s termination of the contract with Karen is the basis of DDS’s argument that Mercy is not receiving services from a Qualified Provider.
As I noted in a written statement that I sent on November 17 to the hearing officer, Mercy had been in several shared living arrangements before she met Karen that were not successful and that left her in a depressed and dysfunctional emotional state. We think placing Mercy with a different shared living provider than Karen would risk a return to the unsuccessful placements of the past for her and would risk undoing the emotional and psychological progress she has made with Karen. Those are risks that we think may be quite high.
We are urging the hearing officer to decide in favor of Mercy Mezzanotti’s appeal to retain her eligibility for services from DDS.
We are also requesting that the hearing officer either order or advise DDS to refer Karen to a new payment agency in order to allow Mercy to continue to receive shared living services from her.
Mother says daughter’s health has declined at day program where she has few meaningful activities
At her day program in the Liberty Tree Mall in Danvers, Mia Cappuccio spends lots of time either walking around the mall with other clients, isolated from the community, or engaging in computer games and a handful of other repetitive and mundane activities, according to her mother Jeanne.
Jeanne said Mia has told her she has asked many times to participate in job training and internships at Parcels, a boutique in the mall. Parcels is run by the Northeast Arc, a corporate provider to the Department of Developmental Services (DDS). Northeast Arc runs both Mia’s day program and her group home.
According to Jeanne, Mia says the day program director repeatedly responds to her requests to work at Parcels by saying she will “‘look into it,'” but nothing ever comes of it.
Since Mia began attending the day program in October 2021, the staff have allowed her, over Jeanne’s objections, to buy candy and lemonade at the Five Below store there. Jeanne thinks the combination of Mia’s sugar intake and lack of exercise at the day program may have contributed to her development of diabetes, which was diagnosed in October.
Yet, Jeanne says, neither Northeast Arc nor DDS, which funds the provider agency, appear to recognize the problem.
Jeanne said she has requested that the day program staff help Mia to make better food choices, and provide Mia with activities other than making purchases in mall stores. But, she said, the day program management have responded that while they encourage Mia to make good choices, it is Mia’s “human right” to buy what she wants.
Jeanne said the day program management suggested that the solution to the problem is to take Mia’s debit card away from her or to suspend her participation in the program altogether. Jeanne maintains that neither of those suggestions are constructive because neither would provide Mia with cues for appropriate behaviors or with usable skills.
Mia and Jeanne Cappuccio
Mia’s day program is called STEP ( Skills Training Exploration Program), and is described on the Northeast Arc website as helping participants “build work and life skills.” But, Jeanne said, little or no such skill-or-work-related training is being provided to Mia in the program.
Mia, who is 26, has a moderate intellectual disability. She has lived in three group homes run by three different DDS providers; but Jeanne said that none of those settings have met her needs as required by DDS regulations.
We are hearing more and more from families and guardians that the COVID pandemic hastened a decline in overall care and services in the DDS community-based system. The decline has been marked by an ongoing staffing shortage. But Jeanne maintains the staffing shortage doesn’t fully explain the lack of meaningful activities provided by Mia’s day program.
Jeanne said Northeast Arc frequently extols its programs on social media and in podcasts. Recently, a Northeast Arc executive contended on a corporate podcast that the organization has helped more people with disabilities secure employment during the pandemic than in any previous year. “As I listen or read these things, I wonder – who does this apply to? Why isn’t this Mia’s reality?” Jeanne wrote to us.
Declining health
Jeanne said Mia’s mental and physical health have declined in the past several months. In addition to diabetes, Mia was diagnosed earlier this year with metabolic syndrome, a condition that can increase the risk of heart disease and stroke. She also developed fatty liver disease a year ago as well as narcolepsy.
Jeanne said Northeast Arc recently developed a behavior plan to address these issues; but she termed the plan “weak,” and said the staff are “woefully undertrained.” Also, she said, the plan has been implemented in Mia’s group home, but not at her day program.
Seeking self-directed model and requesting a change in placement
Earlier this year, Jeanne asked DDS officials whether the Department’s “self-directed services” model might work better for Mia than the traditional model of care under which DDS directly funds corporate providers to provide residential and day program services. Although DDS has been operating self-directed services programs since the late 1990s, the state Legislature authorized a major expansion of those programs in 2014 with passage of the “Real Lives” law.
Jeanne said provider and DDS officials met with her to discuss her self-directed services proposal, and recommended for the first time last month that she explore a shared-living arrangement for Mia. Jeanne said they told her the self-directed model could be made to work with shared-living services.
Jeanne said she and her husband Tom have agreed to explore the shared-living model, although she said Mia has said she would like to remain in a group home. Under the shared-living proposal, Mia would live in a home near her parents. A shared-living setting is run by an individual provider.
Jeanne said she and Tom also asked to explore another group home placement for Mia, particularly one that is state-operated. As we have reported, staff in state-run group homes and Intermediate Care Facilities in Massachusetts are better paid and better trained than their counterparts in the corporate provider-run group home system.
Jeanne said the response from DDS, though, has been that they typically refer only medically complex and highly clinically or behaviorally challenged individuals to state-operated facilities, and that those settings would not be an appropriate peer match for Mia. She added that DDS has also claimed residential placements are scarce, and there are no other residential placements in the Cappuccios’ community.
We disagree that state-operated placements are only appropriate for a restricted set of clients. In any case, it appears that Mia’s medical needs have become more acute in the past year.
Lack of exercise and concern over diet
Jeanne said that in August, when Mia’s gastroenterologist diagnosed Mia with fatty liver disease, he recommended a half-hour-a-day exercise program for her, five days a week, and a low fat diet.
To date, Jeanne said, Mia has no regular exercise program either at her day program or in her group home. She said staff maintain that they encourage Mia to exercise and eat healthy foods, but that they contend she is a picky eater and she refuses exercise.
In September, with Mia’s health issues unaddressed, a sleep specialist at Mass Eye and Ear determined that Mia was experiencing excessive daytime sleepiness and that she might have narcolepsy, Jeanne said. In late October, her primary care doctor stated that Mia’s condition had shifted from prediabetic to diabetic. The doctor’s notes stated that Mia’s group home was working on diet and exercise programs for her; but Jeanne said the group home has not been doing that.
Based on email correspondence between Jeanne and the day program staff, it doesn’t appear the staff have recognized the extent of Mia’s concerns. On November 4, a day program manager emailed Jeanne to say that Mia “has made a lot of progress and is doing really well. Mia has expressed on several occasions that she enjoys being in program and the activities that we provide.”
There was no acknowledgement in the program manager’s email of Mia’s health problems.
Three days later, Jeanne emailed the day program manager to say that medical lab results over the previous year had iindicated that there might be a correlation between Mia’s development of diabetes and her participation in the day program. In that email, Jeanne wrote that:
Mia has been purchasing candy, cookies and a liter of lemonade frequently at her day program. She has been experiencing fatigue and falling asleep often. It has been a vicious, unhealthy cycle. She needs support to manage her health, rather than her social behavior.
That same day, November 7, Jeanne brought the group home and day program situation to the attention of Kelly Lawless, the DDS northeast regional director. She wrote:
Direct care staff members have been quick to respond to correspondence and they appear to have good intentions. However, her programming has not met Mia’s needs and has resulted in a decline in her health and wellness. Her programming has substantially contributed to her development of metabolic syndrome, including diabetes.
Northeast Arc official contends the day program provides activites and exercise
In an email on November 21 to both DDS Commissioner Jane Ryder and to Northeast Arc CEO Jo An Simons, I asked for a response to Jeanne’s concerns about Mia’s day program and her request for a new placement for her.
Timothy Brown, chief innovation and strategy officer at Northeast Arc, responded with an email, stating that Mia had started in a class at her day program called “Health Matters,” and that she had “consistently made healthy eating choices” due to the class, and had not purchased any candy since her diabetes diagnosis.
Brown also contended that Mia has participated in “structured classes and programming that focus on employment goals and is exploring specific internship opportunities that were identified during these classes where she expressed career interests.” He didn’t identify those goals, and didn’t respond to a follow-up email seeking specifics about the internship opportunities and classes.
Brown also maintained that Mia has had “ample opportunities for physical exercise during the day.” He said those activities incude walking “alongside community members each morning prior to the mall opening”; day trip opportunities outside of the mall, and options during inclement wealther for Zumba and aerobics. He also said Mia attends the YMCA at least two times per week with her housemates, and uses an exercise bike on days she chooses not to go to the Y.
Exercise claims disputed
Jeanne, however, said in late November that she determined, based on Mia’s debit card transactions, that Mia has continued to go to pizza and barbeque wings restaurants in the mall at least once a week, and has continued to eat candy and sugary foods. She also said Mia told her that the instructor for the Health Matters class had been out for weeks and was out indefinitely. One of two of the provider’s care staff were taking turns running the class, she said.
Jeanne added that Mia told her the other activities in the day program primarily consist of computer games such as Jeopardy, Wheel of Fortune, and a game she has repeatedly played called Spent. A reviewer described Spent as a “harsh and often bleak” simulation of a situation in which the players are facing poverty and must figure out how to survive for 30 days on their last $1,000. “It is not appropriate or relevant and I don’t think it is intended to be played repetitively,” Jeanne told us.
Jeanne also said that, based on her review of the YMCA records, Mia has been to the Y 34 times in the past 11 months, which averages out to just over three times a month.
I have not received a response from Ryder to my November 21 email seeking her comment on the situation.
In our view, it is cases like this one that indicate whether a state agency such as DDS is effective in its management and oversight of its provider-run programs. When a provider can’t seem to recognize that a client in its care is experiencing severe health problems as a result of the policies and practices of that agency, the evidence begins to mount that the system is broken.
We would join with Jeanne in urging DDS to find a new and successful placement for Mia, preferably in a state-run facility. Given that Mia’s health is declining, DDS can’t afford to let the situation continue any longer.
COFAR blog 