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Developmental Disabilities and Deinstitutionalization

Deinstitutionalization: The Right Thing to Do

1. Most of the “developmental centers” were built between 50 and 100 years ago and were designed for many times the number of people they now house.  The cost to provide services to people in this mode of service is far less than the cost to provide services in the community.

A. True

B. False


2. Research consistently demonstrates that people with ID/DD achieve better outcomes in community setting than when institutionalized.

A. True

B. False


Deinstitutionalization is the Right Thing to Do

3. The history of Fairview includes which of the following?

A. Labeling individuals with developmental disabilities as inmates.

B. Performing forced sterilization.

C. Using inhumane devices to restrain or control patients.

D. All of the above are part of Fairview’s history.


4. Between 1963 and 1987, Fairview residents were more than _____ times as likely to die from unnatural causes as non-institutionalized people in Marion County.

A. 1.5

B. 2.0

C. 2.5

D. 3.0


5. Some residents have been forced by the institution workers to fight one another while employees taped the fights on their cell phones.

A. True

B. False


Deinstitutionalization is a Civil Right

6. Deinstitutionalization and the development of a strong community-based system is considered which of the following?

A. The morally right thing to do.

B. The ethically right thing to do.

C. A civil rights issue.

D. All of the above.


7. In crafting the ADA of 1990, Congress found that the Nation’s proper goals regarding individuals with disabilities are to assure all of the following except which item?

A. Equality of opportunity.

B. Full participation and independent living.

C. A paid college education or skill trade licensing.

D. Economic self-sufficiency.


8. Unjustified isolation is properly regarded as discrimination based on which of the following?

A. Disability

B. Harassment

C. Retaliation

D. None of the above


9. The Olmstead decision requires community placement when which of the following conditions are met?

A. The person can handle or benefit from community placement.

B. The transfer is not opposed by the affected person.

C. Community placement can be reasonably accommodated.

D. All of the above conditions must be met.


10. The Olmstead case originally focused on people at risk of institutionalization, including those on waiting lists, but subsequent cases have applied Olmstead to those currently in an institution and seeking community-based care.

A. True

B. False


Evolution: From Institutions to Community

11. The movement from institutions to community is heavily influenced by the role of which funding source in each state’s plan?

A. Medicare

B. Medicaid

C. Private funding

D. State funding


Community and the HCBS Waiver

12. The HCBS waiver allows states to received federal matching funds for a variety of residential services and supports to Medicaid beneficiaries who would otherwise require institutional care.

A. True

B. False


13. Which of the following is not one of the main choices available for community-based settings through the HCBS waiver?

A. The relationship between provider and consumer.

B. The number of residents.

C. The number of residents per room.

D. The style of service and support delivery.


14. Which of the following is considered a community-based setting?

A. Independent home or apartment.

B. A parent’s or relative’s home.

C. Foster care.

D. All of the above are examples of community based settings.


Additional Community Program Funding

15. Which of the following programs allows states to receive a 6 percentage point increase in federal matching payments for related expenditures?

A. Money Follows the Person

B. American Recovery and Reinvestment Act

C. Community First Choice Option

D. Community Choice Act


Institutions: Definitions, Populations, and Trends

16. NCD has defined “institution” as a facility of ____ or more people who did not choose to live together.

A. 4

B. 6

C. 8

D. 10


17. Which of the following is not one of the ways a coalition of self-advocates defined institutions in 2011?

A. Enforce the food items allowed to be eaten.

B. Include only people with disabilities.

C. Do not permit residents to lock the door to their bedroom or bathroom.

D. Restrict access to the telephone or internet.


Deinstitutionalization: Goal and Strategies

18. The goal of deinstitutionalization is to move people with ID/DD out of segregated institutions to integrated lives in the community with services and supports.

A. True

B. False


19. Which of the following is a benefit of community living compared with living in an institution?

A. An increased quality of life for people with ID/DD.

B. Cost savings for the government.

C. The opportunity to use savings to provide services to people who are not served.

D. All of the above are benefits.


20. Transitioning people from an institution to the community begins with a plan for each resident and results in each person living in which of the following?

A. A residential setting

B. A home

C. Their own apartment

D. Assisted living


21. To make a system work, it is important to develop a plan that includes which of the following?

A. Identifying allies and partners and their roles.

B. The creation of a robust community-based system of care.

C. A commitment to quality assurance involving a diverse group of stakeholders.

D. All of the above.


Strategies for the Deinstitutionalization Movement

22. Individual rights are at the core of the litigation surrounding institutional closure.

A. True

B. False


23. The legal consensus, developed over years of litigation and currently being enforced by DOJ, is that people have a fundamental right to which of the following?

A. Live in the least restrictive environment that meets their needs.

B. Be provided heath care.

C. Have access to nutritious food.

D. All of the above.


24. Under the Care Act of 2010, it is especially important to know all of the following except which item?

A. Basic rules on eligibility and costs.

B. Basics of your state plan.

C. Where the funding for each item is coming from.

D. Provider rate structure and its impact on service availability, specifically the availability of medical and dental providers.


25. The deinstitutionalization plan should specify how the state agency will ensure that the standards of care identified in the plan will be monitored and what corrective action the state will take if it determines that care is not meeting those standards or is not being provided at all.

A. True

B. False


26. The basic strategies that are key to all successful system change efforts needs the support from all of the following except which?

A. The state agency

B. The community voters

C. The governor

D. The legislature


Forging Ahead: Developing a Plan and Building Community Capacity

27. Medicaid pays for routine dental care in 49 states.

A. True

B. False


28. Many service providers are unwilling to accept Medicaid reimbursement because they believe it is inadequate.

A. True

B. False


Overcoming Misconceptions: Myths and Realities - Myth 1

29. In the first six months of operation, the mobile crisis units were able to resolve three out of four cases at the person’s home, either immediately or through intensive in-home supports.

A. True

B. False


30. Among those cases that the MCUs were not able to resolve at the home were successfully resolved within 3 months.

A. True

B. False


31. Since the implementation of the Georgia Crisis System, there has been a _____% drop in incidents involving law enforcement.

A. 25

B. 40

C. 55

D. 70


Overcoming Misconceptions: Myths and Realities - Myth 3

32. A number of studies and state cost estimates consistently find that although community-based services might be better for the resident, they are more expensive than the institutional setting.

A. True

B. False


33. The cost-effectiveness of community-based care is reasoned to be possible for which of the following reasons?

A. The employees of large state institutions are generally unionized state employees who have much richer compensation packages than the people staffing private community-based services.

B. Institutions have a high fixed cost of maintaining the facility and ancillary services.

C. People with developmental disabilities and their families or guardians begin to request less intense levels of specialized care over time than is typically provided in institutions.

D. All of the above.


Overcoming Misconceptions: Myths and Realities - Myth 4

34. Which of the following is the major source of funding through the ICF/DD program for people with ID/DD who live in institutions?

A. Medicare

B. Private funding

C. Medicaid

D. State funding


35. Other funding for community-based services comes from the Social Security Administration, through SSI and the SSDI, Adult Disabled Children program, which provide direct payments or cash benefits to people with disabilities.

A. True

B. False


36. The cash benefits through SSI and the SSDI are available to people with disabilities who live in institutions.

A. True

B. False


37. Congress began offering states the option of including the ICF/DD program as a Medicaid benefit in 1971.  A state could opt to include the program in its Medicaid plan or it could continue to fund its institutions without federal financial participation.

A. True

B. False


38. In exchange for the Medicaid funds, institutions had to comply with federal requirements for all of the following except which item?

A. An approved diet

B. Safety

C. Staffing levels and qualified professional staff

D. Appropriate active treatment


39. Medicaid contributes matching payments to states, ranging from _____% to _____%, on the basis of per capita income, giving states with lower per capita income a higher matching rate in an effort to equalize their ability to fund health care services.

A. 20, 35

B. 40, 78

C. 50, 83

D. 60, 92


40. Which of the following is true about the HCBS waiver program?

A. The program allows states to waive specific Medicaid regulations, including the requirement to provide the same services to all eligible Medicaid beneficiaries.

B. This waiver allows states to cover a limited number of people or to offer the services only in certain geographic locations.

C. The waiver allows states to offer different groups of people different sets of services.

D. All of the above are true.


41. Under the HCBS waiver, each state can choose exactly what to offer, tailoring a package of services and defining the services to fit the target population of the particular waiver program.

A. True

B. False


42. Once a person is enrolled in a waiver program, the state may limit access to covered services, even if those services are necessary to ensure the patient’s health and safety.

A. True

B. False


43. Since housing is an allowable expense under Medicaid, the cash benefits along with additional supplementary benefits provided by some states are often used for housing in the community model.

A. True

B. False


Overcoming Misconceptions: Myths and Realities - Myth 5

44. Since almost all states have waiting lists for services, the people who are leaving an institution must now compete with those on the waiting list.

A. True

B. False


45. A community resident might qualify for Medicaid and meet the level-of-care criteria for the HCBS waiver but still not receive services because the state has reached its preset limit.

A. True

B. False


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