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Former DDS official asks why an intellectually disabled man can’t get basic services
Ken Moran, a former assistant area director with the Department of Developmental Services (DDS), has been an advocate for Steven Voisine and for Steven’s mother Deborah for several years.
Now living in Florida, Moran still keeps in touch with them, and wants to know why Steven today can’t get the basic services he needs from the Department.
Steven, 37, once had an ideal living arrangement in an apartment with roommates in Lowell. But it all fell apart in 2020, after a DDS-funded corporate services provider allowed a known drug user and dealer to live in the residence.
The drug dealer, whose name was Nick, died of a drug overdose that year. But Ken, and Steven’s mother Deborah, said the provider, the Cooperative for Human Services (CHS), falsely blamed Steven for Nick’s problems; and Steven was forced to move out. Meanwhile, they said, Nick had been stealing Steven’s antipsychotic medications.
No longer getting services
Having lost what had initially been an ideal residential arrangement, Steven went on to live in an array of residential settings, Deborah and Ken said. He experienced temporary homelessness and received minimal case management.
Even though he is 37 years old, he moved into his current apartment in an elderly housing building in Gardner. Ken noted that there is no staff support for him during the day.
Although Steven is under the care of the DDS North Central Area Office in Fitchburg, “They (the area office) don’t know what to do with him or with their other clients,” Deborah maintains. “They just tell us they are overbooked.”
Ken said DDS has most recently offered to find a MassHealth-funded day habilitation program for Steven. But that’s not what he wants or needs.
“He needs someone to actually listen to him,” Ken said. “He needs an apartment with shared responsibilities. He needs someone to help him get his place in order.”
Steve and Deborah Voisine and their pets, Tom (left) and Oscar (right)
Ken noted that Steven “gets overwhelmed,” is obsessed with electronics, but has no concept of money. He is also unable to keep his apartment clean, and has no social activities or services.
Ken, who is also a former DDS group home licensure and certification inspector, recently retired as chief operating officer of Opportunity Works, a DDS day program provider.
Deborah has track record of accuracy
Ken maintained that Deborah has fought for years for adequate care and services for her son. “Debbie has been pooh-poohed by DDS for years,” he said. “But there is always truth in what she is saying.”
He maintained that Deborah has always tried to alert the Department and providers to potential problems with Steven’s care. One threat she noted was the admission of Nick to Steven’s shared living apartment.
Deborah said Steven had been happiest when living in the Lowell residence with two other DDS clients. Overnight staff stayed on the third floor of the building. There were 20 hours of staffing during the week. But when Nick was admitted, he brought in pot parties, drug addicts, and prostitutes, Deborah said. Ken said Nick had a history of drug abuse and arrests. His mother would bring pot to him.
Steven and Deborah believed Nick was stealing Steven’s medications to sell to drug dealers, so Deborah bought a lockbox for Steven to keep the medications in. They contended DDS knew Nick was a drug user, but still placed him in the apartment.
False accusation against Steven
One day in the fall of 2020, Ken, who had previously retired from DDS, drove Steven to Deborah’s house in Leominster for a weekend visit.
Steven brought his bag of clothes with him in a duffel bag. That Sunday, he called the manager of the shared apartment to ask if he could stay longer, and asked whether the staff could bring his medications to him.
Deborah said that when the manager went into Steven’s room to retrieve his lockbox, she found that the lockbox was gone. The manager called Steven to ask where it was, and he replied that he had left it on his dresser.
Deborah said the staff did a search of the entire building including the garbage and cellar. The lockbox was never found. But the staff nevertheless accused Steven of having taken the lockbox in order to place the blame on Nick for having taken his medications.
Ken and Deborah maintained that accusation against Steven wasn’t true. Steven subsequently had no antipsychotic medications for 10 days, and his psychiatrist wouldn’t prescribe any more.
Nick died of a drug overdose a few months later, in December 2020. Steven’s pill bottles found in Nick’s room when he died, Deborah said.
As noted, Steven was forced to move out of the residence. In our view, this amounted to an eviction by the provider. We think DDS should have informed Deborah of her right to challenge it.
What Steven needs
Ken and Deborah maintain that it wouldn’t be difficult or expensive to serve Steven properly. DDS would need to gain an understanding of his needs. As Ken explained, Steven needs the following services:
- Help managing money
- Help in keeping his apartment clean
- Assistance with hygiene
- Help in making friends
- Help in dealing with depression and weight gain
- Help in dealing with anxiety
- Help with medical and dental care
“He had this kind of support when he lived in Lowell,” Ken said. “He needs good roommates and some staff support. The right living situation could work for him.”
‘The forgotten children’
Deborah said there are many other DDS clients under the care of the North Central Area Office in Fitchburg, who are in the same situation as Steven. “We call them the forgotten children,” she said. She said she was told the service coordinators in the area are overwhelmed. Some have as many as 70 clients.
Both the director of the Area Office and the assistant director have left the office, and have not been replaced, she said. There is currently an acting director.
Deborah said she recently met with DDS Central West Regional Director Anthony Keane, who maintained that the only options for Steven are living by himself or in a group home. Neither option are suitable for Steven, Deborah said.
For the past several years, DDS has become increasingly unable to meet the needs of its clients. Long wait times for services are now the norm.
As we have said before, DDS has been contending with a shortage of staffing and resources, but has not attempted to make use of its existing assets such as the two remaining developmental centers or its state-run group home system. The Department routinely rejects requests for placements in its state-run residential facilities.
When basic services are unavailable for longtime DDS clients like Steven, and when terms like ‘forgotten children’ are used to describe them, it should be a wake-up call to the administration. Unfortunately, this administration appears content to muddle through, and is apparently not listening to many of its clients or aware of what their needs really are.
DDS finally agrees to allow client to stay with shared-living caregiver; but caregiver’s payment will be cut almost 50%
A year after having disenrolled Mercy Mezzanotti from her shared-living program, the Department of Developmental Services (DDS) finally agreed this past spring to allow Mercy to continue to receive shared-living services from her longtime caregiver, Karen Faiola.
But before doing so, the Department’s Worcester area office reassessed Mercy as a candidate for shared-living services, and increased her assessed level of functioning. That move, according to Karen, will cut her previous income for caring for Mercy by close to 50%.
A higher level of functioning implies a lower level of needed services. However, both Karen and Mercy contend that Mercy’s needs and level of functioning have not changed. Mercy was found by DDS in 2004 to qualify to receive Home and Community Based (HCBS) as well as institutional services from DDS.
“They are continuing to punish us,” said Karen, referring to the DDS area office. Karen and Mercy claim both DDS and Venture Community Services, Karen’s former shared-living contract agency, retaliated against them after they alleged that Venture employees abused Mercy emotionally last year.
Karen Faiola and Mercy Mezzanotti
As we argue below, it also appears that the DDS reassessment of Mercy did not comply with departmental regulations. The regulations require that such an assessment be done by a qualified eligibility team and that notice of the reassessment be provided to Mercy.
Income for caring for Mercy would decline from $38,000 a year to $20,000
Karen said she was told last month by Mercy’s new shared-living contract agency that as a result of the new assessment by DDS, her previous annual income for caring for Mercy will be reduced from $34,000, which she had earned under the Venture contract, to roughly $20,000. Also, she will no longer receive a $4,000 respite allocation for providing services.
Both Karen and Mercy contend the DDS Area Office has deliberately sought to reduce Karen’s pay as part of a continuing vendetta against them for having complained last year that two employees of Venture had emotionally abused Mercy. Karen said the pay cut will it very difficult for her to continue to care for Mercy and to survive financially.
Contract termination followed by involuntary removal from home and disenrollment from program
Mercy has been living in Karen’s Sutton home for the past five years. Karen had been Mercy’s paid shared-living caregiver from 2018 until Venture terminated its contract with Karen in May 2022 without providing a stated reason for the termination. DDS pays corporate providers such as Venture to contract directly with shared-living caregivers.
Prior to the contract termination, Mercy and Karen had complained to Venture that a Venture job coach and a second Venture employee had emotionally abused Mercy.
On the same day that Venture terminated its contract with Karen, a Venture employee removed Mercy against her will from Karen’s home and placed her with another caregiver in Worcester whom Mercy had never met.
When Karen, at Mercy’s insistence, brought Mercy back to her home two days later, DDS moved to disenroll Mercy from its federally reimbursed HCBS program. DDS argued that in leaving the stranger’s home, Mercy was refusing DDS services.
Meanwhile, both Karen and Mercy’s therapist filed complaints with the Disabled Persons Protection Commission (DPPC) of abuse of Mercy by Venture. However, a subsequent review by DDS did not result in any findings concerning those charges, indicating that the charges were not investigated.
In July 2022, Mercy appealed her disenrollment to DDS. In February of this year, a DDS-appointed hearing officer upheld the disenrollment, but left the door open for Mercy to “work with” the DDS area office to reapply for shared-living services.
Melanie Cruz, Mercy’s service coordinator supervisor in the DDS Worcester area office, subsequently told Mercy she would refer her to a new shared-living contract agency. But Cruz then texted Mercy in March to say she would have to undergo an eligibility “reprioritization” before she could be “considered for residential services.”
By that time, Mercy had been without a shared living program for more than a year after Venture’s termination of Karen’s contract. Mercy has nevertheless continued to live with Karen, who continued to provide shared-living services to her without financial compensation.
DDS regulations appear to have been violated: No eligibility team and no notice
DDS regulations (115 CMR 6.02(3)) require that eligibility for DDS services be determined by “regional eligibility teams,” each of which must be comprised of a licensed doctoral level psychologist, a social worker with a master’s degree, and a “Department eligibility specialist.”
Karen said the eligibility reassessment of Mercy was carried out in April by Cruz, the service coordinator supervisor, who is employed by the Area Office. In an email I sent on Tuesday to DDS Commissioner Jane Ryder, I stated that having Cruz undertake the reassessment, on its face, does not appear to comply with the regulations.
In addition, the regulations (115 CMR 6.03 and 6.08) state that after completion of an eligibility determination or redetermination, the regional eligibility team must notify the individual of the determination and their right to appeal within 30 days after receiving the notice.
However, Karen said that as of today (August 4) Mercy still had not received a notice of the reassessment. On Tuesday, Mercy texted Cruz, asking for a copy of the reassessment. But Mercy has not received a response from her, Karen said.
Cruz had previously testified against Mercy
In questioning Cruz’s rationale for reassessing Mercy’s level of functioning, Karen also noted that Cruz had previously testified in favor of Mercy’s disenrollment in a November 2022 DDS hearing on Mercy’s appeal. Karen said she believes Cruz was therefore facing a conflict of interest in subsequently reassessing Mercy for shared-living services.
Reassessment reportedly states that Mercy was without services for the past year
Karen was informed that one of the reasons cited by Cruz for the increase in Mercy’s level of functioning was that Mercy was living “unsupported for the past year.” If that statement is actually contained in Cruz’s reassessment, it is untrue. Karen, in fact, continued to support Mercy over the past year. The only difference between that period and the period prior to it is that Karen was not paid over the past year for caring for Mercy.
It appears that the DDS area office has mishandled this case from the start and has carried out what appears to be a vendetta against Mercy and Karen for having reported the alleged abuse against Mercy.
At the very least, we think, a properly constituted regional eligibility team that is independent of the DDS Worcester area office should assess Mercy’s functional level for shared-living services. DDS should then approve a realistic payment schedule to Karen for providing those services.
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.
COFAR blog 