Representatives from the Department of Mental Retardation spoke at the November CRC Info Session. Speakers were:
The Massachusetts Department of Mental Retardation (DMR) is the primary state agency providing assistance to those with mental retardation. According to their Mission Statement, the DMR “is dedicated to creating, in partnership with others, innovative and genuine opportunities for individuals with mental retardation to participate fully in, and contribute to, their communities as valued members.”
The DMR divides the state into four regions for service provision, with each region including several area offices. The eligibility determination process begins when the patient or family contacts the patient's local DMR office. The Regional Intake and Eligibility Team then complete the intake process.
For adults, DMR recently started using the Massachusetts Comprehensive Assessment Process (MASSCAP) to determine what services a client qualifies for. There are four elements to the MASSCAP:
MASSCAP will be part of the intake process for all new adults applying for DMR eligibility, as well as clients whose service needs are being re-evaluated.
Referring to DMR as soon as the patient is diagnosed with a developmental disability is crucial. The sooner an individual is involved with a DMR office, the better their needs can be identified and addressed.Unless the patient is in a crisis situation, applicants are likely to be placed on an extensive waiting list.
Each area office has service coordinators whose primary responsibility is reviewing the ongoing services of their clients. Social workers who have questions regarding a patient should contact the service coordinator in the patient's area office. Because service coordinators are frequently off-site visiting clients, each reports to an onsite supervisor who is also able to answer questions questions can also be directed to their onsite supervisors.
Each area office also has at least one RN. Service coordinators prioritize access to RN services. Psychology services are also available through area or regional offices. Dental services, occupational and physical therapy are available at the Developmental Centers at Fernald and Wrentham. Speech/Language Pathology and adaptive technology services may also be available on a case-by-case basis.
Levels of support and services in residential settings vary widely. The goal is to allow most people to be served in their communities. Residential group housing is prioritized by level of support needs, and is available to those with high levels of need for assistance with ADLs, behavioral supports and/or medical care.
The majority of DMR clients reside in the community as opposed to a residential facility. Many of the educational and support services available to clients under age 22 are provided by the local school district, which DMR supplements when necessary.
Medication Administration in Residential Settings
Non-licensed staff receive 16 hours of training to give medication to patients who cannot self-medicate. During hospital discharge planning, it is important for hospital personnel to understand that facility staff require very specific provider orders to administer medications. They cannot make clinical decisions, such as determining when to administer meds if prescribed “as needed.” The physician needs to be very specific. If possible, make sure a medication information sheet is available. MAP staff cannot administer insulin, however, so if the patient cannot be taught, this can present a difficult discharge planning dilemma.
UMass Medical Center in Worcester has one unit, “8 South”, dedicated to people with dual diagnoses of mental illness and mental retardation. It is an eight-bed unit. Because of limited bed availability, admissions must be planned and emergency referrals are not accepted. The majority of admissions involve patients requiring medication review. The length of stay averages 8-12 days.
Lemuel Shattuck has a unit for medically acute patients with concurrent behavioral issues only. Patients must be at an acute level of care; if a medical work-up has already been completed, placement may not be appropriate.DMR often connects people with ARC (Association of Retarded Citizens) Massachusetts to teach families to advocate for themselves, provide social groups for clients, and provide respite for caregivers.
When a patient has both developmental disability and mental health diagnoses, the DMR is the lead agency. DMR has more services available, and will collaborate with the Department of Mental Health to assure optimal services.
Challenges Facing DMR
Since they have limited RN hours, DMR relies on community skilled homecare companies to provide skilled nursing care. Given that DMR clients, like the rest of the population, have increasing life spans and are developing more age-related medical complications in addition to previous impairments, this poses an increasing challenge .
Staffing issues pose another challenge for DMR. Low wages and complex demands make it difficult to recruit and retain quality employees.
For a list of DMR regional and area offices, see the Social Service website - http://healthcare.partners.org/ss/ssframebottom/staffresources/New%20Site/Special%20Populations/DMROffices.pdf
Massachusetts Department of Mental Retardation – www.mass.gov/dmr
Fernald Center (after-hours calls) – 781-894-3600
UMass Medical Center/Worcester “8 South” – 508-856-2939
-Thanks to Deborah Herst-Hill and Susan W. Lerner for their thoughtful presentation and Deborah Herst-Hill, RN for her help with this article.
11/2005