Auditors find troubles at DIDD and see looming caregiver crisis

In an audit of the state Department of Intellectual and Developmental Disabilities released today, the state comptroller’s office found shortcomings in several areas and included an “emerging issue” observation that the state faces “a critical shortage of caregivers for individuals with intellectual and developmental disabilities.”

The full audit is HERE. A list of ‘key conclusions’ (including the reference to page numbers in the audit):

 The department did not provide case management to individuals on the Medicaid waiver waiting list according to policy, did not make adequate attempts to communicate new aging caregiver legislation, and again did not maintain the current needs status of supported individuals (page 29).

 Concerns emerged before, during, and after the launch of Employment and Community First CHOICES (page 47).

 Although the department has made improvements since the prior audit, it did not properly develop or review Individual Support Plans in some instances (page 70).

 The Office of Risk Management and Licensure did not perform annual reviews of problematic areas identified in our prior two audits, leading to nine repeated findings (page 81).

 For its employees directly caring for individuals with intellectual disabilities, the department did not perform background checks; sex offender, abuse, and other registry checks; and work history and credentials checks timely or at all (page 93).

 The department did not keep track of who volunteered at its facilities; performed criminal background, sex offender registry, abuse registry, and work history checks late or not at all; and accessed sensitive information about volunteers without permission (page 100).

 The department and its providers did not complete required death reviews timely (page 106).

 Continued weaknesses exist within the system the department designed to ensure that individuals with intellectual disabilities receive high-quality care (page 115).

 The department’s policy for granting exemptions for people with criminal records to work with vulnerable individuals contains both design and implementation flaws (page 123).

 As noted in findings for the last 14 years, the department did not implement the internal controls necessary to keep track of the belongings of individuals under its care (page 143).

 Since 2003, the department has lacked adequate internal controls over the use of Resident Trust Fund accounts to make purchases (page 151).

 As noted in our October 2013 audit, the department did not ensure that the money belonging to individuals who died at, or were otherwise transferred from, its facilities ended up with the appropriate parties (page 157)

 Because of the department’s inadequate monitoring, some individuals’ account balances exceeded the maximum allowable amount, risking loss of Medicaid eligibility (page 162).

 The department did not provide adequate internal controls in five specific areas (page 170).

Here’s the Comptroller’s press release:

The Tennessee Comptroller’s Office has released the Sunset Performance Audit for the Tennessee Department of Intellectual and Development Disabilities (DIDD). While the audit report notes several accomplishments, it also includes 14 findings and 9 observations.

DIDD is responsible for administering services for Tennesseans with intellectual and developmental disabilities and has celebrated multiple achievements since the Comptroller’s last audit reports of the department in 2013. These achievements include resolving federal lawsuits, closing the Clover Bottom and Greene Valley Developmental Centers, and becoming accredited by the Council on Quality and Leadership.

In 2016, DIDD collaborated with TennCare to launch the Employment and Community First Choices program to fill critical gaps in the state’s service delivery system. Auditors noted several concerns with the launch of the program including DIDD’s failure to transfer critical information to TennCare about Tennesseans who were on a waiting list for services.

Comptroller auditors also found that DIDD did not always make adequate attempts to contact individuals known to have an aging caregiver. This communication was necessary following the passage of legislation allowing individuals on the waiting list to qualify for additional services if their caregiver was a certain age.

Although DIDD has made improvements since the prior audits in 2013, the Comptroller’s Office still found problems with improperly developing individual support plans, not performing timely background checks and newly required registry checks on employees and volunteers, and not implementing adequate controls over resident trust fund accounts and personal property.

The audit report also describes an emerging issue in Tennessee. The state faces a critical shortage of caregivers for individuals with intellectual and developmental disabilities. This shortage is largely driven by the demands of performing physically and emotionally challenging work at low pay. A 2015 study found that Tennessee ranked last among 16 states in its average hourly wages for both entry-level and experienced direct support professionals.

The Comptroller’s Office will present the DIDD audit report to the Education, Health and General Welfare Joint Subcommittee of Government Operations on December 13, 2017 at 9 a.m.

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