MOMS Report Card: Premier Christy Clark’s solution to the CLBC crisis

Here is an overview of Premier Christy Clark's solution to the crisis in community living, as outlined at a Jan 19 press conference:

1. Funding:

Of the $40 million in "new" funding announced:

• Only $18 million is directed to CLBC operations, of which $9 million was the emergency funding announced last September – leaving $9 million in new money, but an $18 million yearly increase moving forward;
• $12 million is “tagged” by the government from the contingency budget to spend in case of caseload increases;
• $10 million is earmarked from the Ministry of Social Development for day and employment programs and transitioning youth;

Compare this to an estimated $70 million that CLBC needs just to address current waitlists, with at least 3,000 documented unmet requests for support from CLBC-eligible clients on hold. Waitlists grew during a two-year funding freeze in 2010 and 2011 when the number of clients grew by 5% annually. Besides millions needed to resolve the backlog, CLBC needs further budget increases of $35 million in April 2012 and again in April 2013, just to address projected 5% caseload growth for each of the next two years.

Conclusion: Better than zero but this is a Band-aid, not a solution. Stay tuned for more gut-wrenching crises and more outside noise.

2. Independent Advocate:

The Children's Advocate, Mary Ellen Turpel Lafond, will be given a limited mandate to advocate on behalf of youth turning 19 as they transition into adult services. This is very good news for young adults, but it completely fails CLBC's most vulnerable clients -- the hundreds of older clients who have no families to advocate for them, who can't go to the media when they have a problem, and who are unable to access the support of appeal mechanisms like the Advocate for Service Quality or the Client Support Team.

Conclusion: A+ for extending the mandate of the Children's Adocate, and a resounding F for the disgraceful and cynical failure to provide equal support for the more vulnerable older adult population who can't cause Premier Clark the same kind of political pain by describing their abuse/neglect at the hands of CLBC in front of the TV cameras.

3. Deputies' report

This report by senior provincial bureaucrats relied primarily on the internal audit and the CLBC Board's new vision report, released before Christmas. It proposes better coordination of CLBC services with other agencies and during adult transitions, plus more reliance on non-CLBC services (same old, same old).

In short, the Deputies' advice is that families and adults expect too much and that CLBC and its clients should stop complaining and get used to less support from govt.

Conclusion: F

4. CLBC Audit report

Key issues are summarized below:

1) Omissions: The auditors did not acknowledge, investigate or report on most of the troubling allegations around CLBC practices, as raised by families and the media:

• Firing of Vancouver coastal director Paul Sibley, which allegations have linked to contracting practices.
• Serious contracting and practice irregularities noted in the Lister consultants report, as reported by Global News and the Victoria Times Colonist.
• Complaints (Vancouver Sun) that CLBC staff improperly changed needs assessments using the GSA tool to justify contract cuts, or misled home share contractors by failing to be transparent about known risks like violence history, in efforts to reduce contract costs.
• Complaints about abusive/unprofessional contracting practices:  alleged threats, intimidation, or blackballing of contractors who raise health and safety concerns, allegations re preferential awards & of wildly divergent contract values for similar needs. Allegations that moonlighting CLBC staff paid themselves higher rates while cutting other contractors.
• Complaints about oversight failures: that clients were left in home shares with expired contracts, clients whose placement, status and care was rarely or never inspected by CLBC and or agency supervisors.

Conclusion: F. These are serious omissions that seriously undermine the report's credibility. Sweeping problems under the rug will do nothing to restore confidence in CLBC or help the agency get on track! Expect more outside noise.

2.  Projections: The audit admits CLBC has a good handle on projected caseload increases but claims that's meaningless for planning and budget purposes without detailed assessments of exactly what services each future client will need.

It's a ludicrous assertion: In no other arm of this or any other government can bureaucrats predict exactly what will be needed by a consumer who walks in the door a year or two in the future.

3. Waitlists: After months of denying it had any waitlists, CLBC released data in September 2011 showing that 2,126 clients were receiving some services but were waiting for additional or enhanced services; while another 832 eligible adults were waiting and had not yet received any CLBC services.

While imperfect, CLBC's client file management system and waitlist data is better than most other arms of govt. The Children's Ministry, for example, can only guess how many kids most of their programs serve, and claims to have no ability to even estimate unmet service requests.

Yet the government auditors, after reviewing a sample of files from CLBC's Request for Service List (RFSL) and allegedly finding it riddled with errors, concluded that CLBC's waitlist numbers were unreliable and overstated. They concluded therefore that the data did not support the $65 million CLBC has requested from the province to eliminate the backlog, or the new funding required to meet projected caseload increases in 2012 and 2013.

The conclusion is at odds with the results of CLBC's December 2010 customer satisfaction survey, which also addresses the question of unmet needs. The audit cites the survey results, which actually support CLBC's waitlist estimates, and indeed suggest that unmet needs as per CLBC's RFSL may be understated, not overstated. It will be interesting to see the results of the December 2011 satisfaction survey, but it's not clear when that will be released.

QUOTE: "In recent months, CLBC has been subjected to extensive scrutiny and criticism, mostly due to client dissatisfaction. This is reflected in CLBC’s annual client satisfaction survey which in December 2010 indicated a client satisfaction rate of 71%, down from 76% in 2009. Of the clients reporting dissatisfaction with CLBC in 2010, 63% were waiting to receive services."

So 63% of 29% of CLBC's existing 13,700 clients were unhappy because they were waiting to receive services. That works out to 2,500 unhappy clients waiting to receive services a year ago.

A closer look at reported errors in the CLBC waitlists suggest more sloppy work on the part of the auditors:

1. QUOTE: "CLBC allows clients without a completed GSA to identify specific services they would like to receive and have them placed on the RFSL. As a result, the validity of the list is compromised because the requests have not been assessed by CLBC staff."

The draft GSA (Guide to Service Allocation) is not an official policy. It is simply an internal management tool used to ration available resources to meet legitimate community living support needs among eligible clients. It does not establish eligibility or validate service requests (both are determined by Legislation), so this is a nonsensical assertion. CLBC clients and their families must work with a CLBC facilitator to draw up an individual service plan, a lengthy, rigorous & detailed process. All requests from CLBC-eligible adults that are consistent with that plan are legitimate requests. The Deputies' report also acknowledges flaws with the GSA, which has been widely condemned as flawed, subjective and open to abuse.

2 . QUOTE: "Some clients who were receiving CLBC funded services were incorrectly identified in the RFSL as not receiving any services and some clients had not had their priority score adjusted upon receiving CLBC-funded services."

Neither issue would change the overall waitlist numbers, or whether these are still legitimate unmet needs. The auditors are again asserting that only clients who score over 70 on CLBC's internal priority ranking tool have legitimate requests for service. This priority ranking system is simply another internal resource rationing tool, which has no relevance in establishing what are/are not legitimate requests for support from eligible clients.

The auditors make no reference to the 2005 Community Living Authority Act (as amended) to inform themselves or to evaluate the RFSL against CLBC's actual legislated mandate and service eligibility criteria:

QUOTE: "...in relation to the provision of community living support, the authority must endeavour to

(a) offer a range of funding and planning options that promote choice, flexibility and self-determination, for example, individualized funding, independent planning support and the involvement of community resources,

(b) promote choice and innovation in the manner in which services are delivered,

(c) encourage shared responsibility among families, service providers and community resources,

(d) utilize and further develop the capacity of individuals, families and community resources,

(e) assist adults with developmental disabilities to achieve maximum independence and live full lives in their communities,

(f) promote equitable access to community living support, and

(g) coordinate the provision of community living support with services provided by the government and community resources..."

Any request for support consistent with the above, submitted by an individual with a "developmental disability" as defined by the Act, and consistent with an individual service plan, is a valid request for service. The RFSL is therefore a reflection of the growing gap between legitimate requests and the extent to which Premier Christy Clark's government is willing to fund CLBC's mandated "endeavours."

CLBC also has other legislated obligations, such as adult guardianship and the Community Care Licensing Act, but the audit also failed to investigate compliance with these responsibilities despite serious allegations raised by stakeholders.

QUOTE: "While CLBC has not been able to fully demonstrate and support their need for increased funding, British Columbia is comparable to other provincial jurisdictions in the amount of funding it provides, based on the average per individual as at 2010/11 as shown in the following graph."

As noted in the Deputies' report, CLBC's eligibility criteria are narrower than the comparator jurisdictions, which means that CLBC is being asked to serve a higher-needs population with the same or less average per capita funding as the other jurisdictions compared in Canada and internationally.

Other issues include... QUOTE: "Services being requested that are not required for several months or years, resulting in the list overstating the current demand for services."

What is meant by "not required"? CLBC has recently been telling elderly parents requesting crisis supports that the requested services are not considerd necessary until within 48 hours of their anticipated death. The failure to evaluate the requests against CLBC's legislated mandate again undermines the conclusion that these are not legitimate unmet needs.

QUOTE: "As at September 30, 2011, there were 2,958 clients on the RFSL of which 2,126 were receiving services but had requested additional or enhanced services; and 832 had not yet received any CLBC services. These numbers are likely overstated given the inherent problems in the RFSL; the true number of clients waiting for new or enhanced services is not known."

Many families reported to the Minister after checking with CLBC and finding their own requests for service, registered in the context of an approved individual plan, were not included in the RFSL. Despite such complaints, the audit team did not investigate how many legitimate service requests were NOT included on the RFSL.

Clearly, some errors in the RFSL are legitimate errors, but not all errors are equal. In addition to the flawed evaluations and the failure to consider legislated mandates, as noted above, the Audit team's vague and misleading assertions failed to quantify how many times they encountered various "errors," and how such "errors" would materially affect the reliability of CLBC's  estimates of unmet need and new funding required.

4. Bias: Viewed collectively, the content of the audit report, with the errors and ommissions noted above, demonstrates a strong, clear bias. In sum, the distinct impression is that this audit was commissioned and directed to achieve a specific objective -- i.e. to undermine confidence in CLBC's waitlist data and projected caseload increases, while dismissing broader concerns about CLBC's management in relation to its legislated mandate, to provide political cover for the Premier's failure to respond to documented needs and concerns.

5. Management salaries: The audit also looks at management compensation, but adds little to what has already been discussed in the media.

6. Conflict of Interest: The single achievement of the audit report was the auditors' discovery that CLBC employees moonlighting as contractors to their own agency was a clear conflict of interest (how is it that CLBC's professional board, CEO and entire management team couldn't see what was so obvious to families in the sector?

Conclusion: The Audit report warrants an F . Families continue to demand an independent review, and CLBC will continue to lurch from crisis to crisis, since it appears to deliberately overlook most of the problems.