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APD Survey- Comments

(*Mostly) Unedited

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Survey Results

Open-ended Responses

  Do you have any comments or suggestions that were not addressed in this survey?

**  COMMENT  **  Last year I was very involved in writing, calling and trying to get parents involved but I am so busy this year because I had so many children under 18 on my case load , my pay went down by about 40 % so I had to take on so many more cases to just be able to stay afloat. I can tell my attentiveness to my clients has been severely reduced as one person simply cannot do that much for clients with a very heavy case load. I try to use emails to be more efficient but honestly out of about 40 clients only 4 have email addresses or computers. It's hard to reach really needy people who are already working two jobs often times, can't afford cell phones, have no computers, can use computers if they have them....it's very frustrating to try to do this job the way I feel it should be done.

**  COMMENT  **  The waiting list is way too long for people that are in desperate need of waiver services.

**  COMMENT  **  allow the support coordinator to do the ABC screen as used to be.

**  COMMENT  **  The Legislators should look at cutting thier costs before cutting anymore Health Care and Education.

**  COMMENT  **  I feel that the cost containment needs to happen but I think that APD has taken the wrong approach. Unless you have actually been out here providing services I don't think that you know how these changes impact the quality of care that is needed.

**  COMMENT  **  Rates for providers do not support gas prices---providers that work for $10 an hour and pay for their own gas limits there ability to provide quality service and medical assistance

**  COMMENT  **  none.

**  COMMENT  **  The key to making the Waiver better is better training not more monitoring.

**  COMMENT  **  How can our consumers be put in a tier when their QSIs have not been finished? Why are they doing the QSI if not to determine the appropriate tier? The attitude at APD about the extended amount of time to approve services is that even if the services will end because there is no approval-this does not constitute an emergency and no contact should be made to APD because nothing can be done.

**  COMMENT  **  the push to cut hours of persons served is killing their chances of living on their own successfully. They attended school or 21 years and most still have no money value concept and poor reading skills etc.--why is it assumed that 5 years in supported living and they can do it all themselves without supervision??????

**  COMMENT  **  I have lost faith in the ability of APD and state government to successfully manage budgets, quality of care and appropriately set priorities.

**  COMMENT  **  If they want to save money, why not start at the TOP and get rid of some of the APD staff in Tallahassee.

**  COMMENT  **  Survey on a couple of question should allow you to mark more than one for example no. 14,7

**  COMMENT  **  The tiers will cut essential services and reflect the idealogy of our state government that individuals with a developmental disability are nonproductive and have no value. Florida's priorities are in the wrong place.

**  COMMENT  **  This entire program has been mismanagned from the beginning...too much money was spent with very little oversight. Families have become dependent upon the system and many are resistnat to change. If every person on the waiver would "volunteerily reduce" their spending, then perhaps there would be additional money for some of the others still waiting.Some families feel they are "entitled" to these services yet do very little to seek out, develop and maintain any natural and generic supports . More families should get together and do more for the consumers. Additionally , if support coordinators would "volunteerilly reduce" some of their consumers to limited ( ie: those on the FSL waiver) perhaps there would be additional money for those on the waiting list. If APD feels that it time for families to begin using more "natural and generic" supports, then perhaps, instead of taking cost plan and assessment duties away from support coordinators and hiring state employees to do this, they should hire state employees to develop a "community organization " unit to outreach services for consumers and coordinate with local colleges, businesses , etc to develop a more comprehensive program of natural and generic supports.APD should also go back to reviewing and approving services locally as well as montioring the reviews of the providers, thus saving money on the present contracted agencies ( maximus, aps and delmarva).In addition, ALF's should not receive RESHAB money until they are licensed and monitored by the state.Lastly, If a person wishes to live on his/her own or remain within the family home, they should become less dependent upon the system to do so. Unfortunately, it can't always be about what the person wants, but how much money the state has...that's just reality...

**  COMMENT  **  Three out of four of my disabled family members will loose services of ADT, Transportation and therapies when they are assigned to the tiers they appear eligable for. APD and the legislature MUST address the serious negative impact the tier system is going to have on both consumers (now known as clients) families and providers.

**  COMMENT  **  REGARDING PAPER WORK.... IT SEEMS ODD TO ME THAT DELMARVA IS MORE INTERESTED IN PAPERWORK THAN ACTUAL CONSUMER CARE!

**  COMMENT  **  Yes, the State employment level with APD is too high. There should be a massive reduction in employees, reduce districts to no more than 5 regions, restructure the LRC (wast of money and time. Also stop using the CQL POM's, this causes to much paper work there sould be thre questions asked, Are You Safe, Are you Happy, and Do you have choices. The MW has become micromanaged thus resulting in greater operating cost.

**  COMMENT  **  As the representative of a CDC+ client, I am pleased to date with APD's assumption of payment responsibilities to providers. Whether it was because of poorly managed contract negotiations or other reasons, the succession of private fiscal agent contractors in recent years were unable or unwilling to do the work properly.

**  COMMENT  **  One of the costliest aspects of the overall program is so-called quality assurance . Delmarva, ACHA, and APD struggle with this. Yet, if support cordiantors were permitted to manage most of the direct care oversight, which they understand far better than these distant agencies, most of what Delamrva undertakes could be eliminated. The overseeing agencies then would need to focus on knowing their waiver support coordinators rather than attempting to know each and every direct care provider.

**  COMMENT  **  We are dealing with politicans who have their own agenda and not the welfare of the most needy, but isn't that the way it has always been.

**  COMMENT  **  I find that too many families out there are still not informed. I do not believe state agencies work together to share information with families freely. Everything is like pulling teeth to get information. It seems common sense and yet many things never happen. I feel sorry for families with out the internet because they have to be lost out there with no supports at all.

**  COMMENT  **  Appoint a director that is experienced, knowledgeable, has advocated for those they will serve, and understands the budget, the overall system, and has credibility with the legislature.

**  COMMENT  **  APD needs to look closer to home when it comes to cost containment. Office/Admin personnel appear to just put their time with no consideration for their actions (or lack thereof). They don't answer their phones and rarely answer emails. They are a bunch of robots who could do with a wakeup call. I would love to see them try to get by with the amount of work they do but do it in the private sector. Them and their boss would have an extremely difficult time out here if profit were a concern and taking good care of your client meant having a job or not. APD Orlando is bureacracy at it's finest! ACHA in Tallahassee is not better either. Most importantly is the fact that with all the changes put in place (ie., 5 hours max per week of SL is the client has IHS) there are no checks and balances. Meaning ; no one is checking to see if the new plans are working and (most important) how they are directly affecting (positive or negative) the consumers! It appears that for the sake of saving money, nothing is sacred. Shame on APD, our Florida legislators and of course, Charlie! If they only knew how bad their decision making has been and how the clients have been adversely affected. That's the point though isn't it. They don't know and it seems that don't care either. I could go on but feel so much frustration I fear my correspondence would digress and therefore be lost in translation. Sorry!

**  COMMENT  **  I just learned that if the consumer goes to a higher teir for example teir 4 and have been receiving services on big waivier that will lost their present services ie Adult Dental and Companion. We should be apble to spent the alot amount on any service.

**  COMMENT  **  VERY IMPORTANT!! With the tier system, there MUST be some sort of allowance for more one time expenses such as dental work or home modifications that should not come out of annual budget. They allow one time expenses on the CDC+ and should make some sort of accomodation with the tier system as well.

**  COMMENT  **  Support coordinators need to become aware of what is going on at the state level and to become aware of what FASC is saying on their behalf. I tried to warn the wscs in my area last fall after attending an FCCF mtg where the chair was saying that support coordinators were saying families with children were coercing them into providing unnecessar services. WSCs are now living with the result of that kind of thinking with reduced pay for families.

**  COMMENT  **  Micromanagement by the legislature has worsened the situation with APD, not improved it. APD needs a strong leader with professional credentials in the DD field, not another political appointee. We need a valid assessment tool, predictable costs and a focus on true basic needs.

**  COMMENT  **  I think we need to address that we need more doctors on the medicaid list. Evelyn Llynn told me to take my grandaughter to the ER but I don't think that is right because they tell you to take her to her primary care doctor. I take her to the Health Department because I could not get a doctor to take her.

**  COMMENT  **  APD employees need to work in a group home or foster home at least three days a month to find out what the problems we face daily really are. Finally, they need to take a cut on their pay checks too for the same as the rest of us.

**  COMMENT  **  I believe that there does need to be a change in the system, but it really does need to be on a case to case basis. There are some individuals receiving an astronomical amount of supports while others cannot get a minimal amount of supports needed to remain an active part of their community.

**  COMMENT  **  I have a wonderful and professional Support Coordinator presently for my Consumers . However, in the past I have found that many Support Coordinators lack professionalism and true concern for people with disabilities. They are laxed in their ability to communicate effectively, do not provide the authorizations accurately or timely , are more concerned about their time being interrupted for their own personal agenda , and often mislead the Consumer and his/her families with policies and procedures . This has been my determination after being a Medicaid Provider for 7-1/2 years . It is my personal belief that they should be held more accountable.

**  COMMENT  **  Quality care and accountability issues are a priority for me.

**  COMMENT  **  We lost 5 WSC's in the last pay cuts, I know more cutsin July and it may effect WSC's. I love this job and have for the 13 years I have been doing this. I work long hours, including most Sundays. The paperwork is killing me, I spend 80% of my days doing paperwork, so little time to spent with my clients. This isn't what I signed up to do so many years ago. I am looking for other jobs, it's just a matter of time before we are all forced out. It will be a sad day when our clients lose their advocates.

**  COMMENT  **  Since APD moved from DCF, problems have increased. I don't believe DCF was better , but the level of management that are in place for APD, both local and in Tallahassee , are inadequate. The "Peter Principle" is going wild in all areas. They need more people with degrees in business versus social sciences running the operation . It does not appear as if anyone is really looking at the expense from recent changes. APD has not increased any level of responsibility by making their staff data entry clerks and making the support coordinators prepare endless data entry forms. The responsibility of decisions have not changed and there is no benefit by what has been done except to increase the workload for everyone and to make more unrest among the consumers and providers. Expenses have been increased, instead of reduced. This would not be done if a strategic management plan was really being used. APD will not listen to anyone and there is one APD employee in Tallahassee , whose first name is Linda, who continues to be the demise of APD. APD will not listen to their providers or consumers even when good suggestions are made to assist in reducing the budget. We should be working as a team, and not as enemies.

**  COMMENT  **  #11 more people added to the waiver as well as quality of care. #14 direct care provider, family member There are many providers commiting fraud causing a waste of money.

**  COMMENT  **  Eliminate limited Support Coordination as mandatory for children in family homes . Make every service available to the FSL waiver. Eliminate the mandatory move to FSL for children in their family home and round off the total to $15,000 (really , where did $14792 come from?) With these changes the Tier system might be a good idea. Families/consumers should have to manage their budget and not have an unlimited amount of money available.

**  COMMENT  **   There are ways of accomplishing cost containment that would be more effective than what they have implemented. They do things so willy nilly and don't research and talk to the Support Coordinators who see what is really going on.

**  COMMENT  **  In other states, Managed care took over Medicaid. After 2 years or so, they saw they were not making a profit and stopped. So...no Managed Care but also no Mediciaid program to fall back on. This could happen to Florida very easily. Meet the new "homeless" population. First it was the mentally ill...now they will be joined by Developmentally disabled. Surely someone can see this coming. WE NEED HELP NOW!! Quit giving tax breaks to big businesses. Put that money into our programs to protect our most vulnerable population.

**  COMMENT  **  apd KNOWS the answer about how to fix it, but FARF has a stronghhold on them and continues to milk the cash cow in the care of people with disabilities. CDC plus is the answer. There is a lot of corruption in our state Senate and that why we will end up with managed care.

**  COMMENT  **  Do you feel personal agendas get in the way of decision making in the APD offices ? Does the monitoring system recognize individual's qualities and experiences, consumer satisfaction, or does it focuss too much on dotting the "i"s and crossing the "t"s? When was the Developmental Disabilites Bill of Rights changed, deleting government non duplication of services?

**  COMMENT  **  APD has made many changes which do not seem to consider the best interest of consumers . And now, APD is placing consumers in tiers according to current cost plans rather than utilizing the QSI assessment. What is the point of the QSI, simply another waste of funds... much like the ICG which was never used. Enough is enough!

**  COMMENT  **  Why not place limits on the funding to each service, such as $16K for PCA. Do away with the levels and have onerate for each service with a cap for the service. People should not be capped.

**  COMMENT  **  if individuals live in a group home do away with their support coordinator that' s why group homes have managers. This would save a tremendous amount of money that could be directed more to the care of the individual. Cut out Delmarva, APD does monthly and yearly inspections, this should be enough, when doing a monthly target one file each month look at everything not just the basics what APD does now with the monthly is a waist of money nothing is accomplished from these inspections. Theres to many middle men that cost more than they are worth. cutting those things would free up millions of dollars that could lower the state budget and provide better services for individuals in need. I as a group home operator feel I provide a quality service and could provide more for the individuals I serve than a coordinator would who visits once a month at best. I have great ideas that would save the state tons of money without hurting the individuals we serve but no one ever asks the providers.

**  COMMENT  **  Adding bureacratic layers and processes does not improve efficiency.

**  COMMENT  **  it is a shame that so many cuts only effect the people on the bottom and very little if any cuts were made on the top. officials getting raises when consumers loose service. it would be a huge step forward for the cuts start at the top and reduce overhead before taking away services that are working to make lives better for all concerned.

**  COMMENT  **  Support Coordinator should have a much larger role in QSI to determine which tier is best for client.

**  COMMENT  **  I agree with what was said at the Summit in Tampa. If we don't work together, we will not work at all!

**  COMMENT  **  I believe that cost containment could be greatly facilitated by looking at caps for individual provider services. My service is behavioral analysis. I believe that most behavioral analysis services could have the opportunity to be effective within a brief period of time. With this strategy in mind, relevant services may be revisited if needed following a period of time of no service.

**  COMMENT  **  My daughter living with Autism, with the help of services provided through the HCB has excelled farther than I ever thought that she would pre-waiver. Because she is under 22 and lives in the family home she will now LOSE most of her services that have assisted her in the past. She relies HEAVILY on these services and she will need to MOVE-OUT of her home to keep services rolling. I am DISGUSTED by this !!!!! I have always wanted Independence for her (as I will not live forever) but this is quite premature for my taste....It seems she has no choice. Sad. Very sad .

**  COMMENT  **  Consumers in the Group Home should have been interviewed BEFORE rates were cut! The Group Home owners should have been contacted in the case of a consumer that can not talk. Why did they go to family members before care takers?

**  COMMENT  **  i am frustrated but will not give up hope because even in bad times someone has to be successful and that will be my agency! i cannot and will not let my consumers down. if you want information now.....you must be aggressive and seek it out because everything is in turmoil and no one seems to know what is going on from day to day....i continue to make calls and check with providers who are honest to find out what the truth is. (as they know it.) and that changes from day to day. i feel like a chameleon trying to change my business and be proactive but yet not sure if what i am doing is correct. very difficult!!! good survey....but the answers could on and on...for example...in my experience with CDC...the client's families hinder their progress...so....i have not had good luck with that.

**  COMMENT  **  Although the rates continue to be cut, APD keeps adding more restrictive requirements .

**  COMMENT  **  Some may think that it is questionable to the intent of WaiverProvider.com when the spouse of the creator is an APD employee. How can this forum be truly neutral when loyalties are with the family and the family is employed by APD. What then is the true intent of the website? To funnel info to APD? To solicit ideas for APD? You just have to wonder...

**  COMMENT  **  ISCs should be elminated, as we can not afford their services any longer in Florida , start with honesty. Rate structures should be simple, understandable by all, and refective of real costs and adjusted for those costs at least annually. Enrollment should be frozen until there is funding available to open it up, then only to the limits of the funding. Quality care costs money, it is not free, it is not cheap , and it has left our state, along with the competent leadership and consumer choice . It is no wonder that APD keeps loosing leadership good or bad (JJ lasted 1 year and about 1 month)at least it only took her that long to realize the above. Communication is at an all time low between APD and the providers is becoming purely punative , which is ineffective for meaningful progress with any problem. Starving providers ,excessive paperwork,regulation and fines, rising costs and falling rates, only forces good providers out. Wake up!!!!

**  COMMENT  **  Providers need access to ABC as well because of all of the mistakes that keep services from being billed in a timely manner.

**  COMMENT  **  When APD wants to make changes, they need to think through all the consequences. They keep putting the cart before the horse, and some people who make the decisions have no understanding of the system itself. By taking ABC away from WSC's they piled massive amounts of work on the districts, and actually put more on WSC's because it takes 4 or 5 phone calls to fix things that are entered wrong. Stop wasting money on stupid ideas that don't work-like QSI's and ICG's, the PSA providers and other nonsense, and put the money towards WSC's who do a great job, and the clients who desperately need services. There has to be tons of wasted money in administration and in Tally. By cutting services and losing WSC's because many are jumping ship, people are going to end up in institutions because their families won't be able to take care of them. Then the cost will be higher in the end. The tier system hurts those whose cost plans are low to begin with - people who only get ADT or companion, transp, respite, CMS, and dental. They'll lose because they'll have to go from $20,000 to $25,000 CP to tier 4, @ $14,792. They're getting very basic services to begin with. Cut from the high end-combine services, reduce something there. You're going to force the most independent people with elderly parents into a group home. That's totally opposite of what should be happening. Remember most of these clients live in rural areas-tranportation is not available to many of them through natural supports. Increase tier 4 to at least $20,000 and include dental and med reviews. These are people we want to keep with families .

**  COMMENT  **  In regards to question 3, there isn't any confusion, it's clear cut, but it doesn 't make sense, and the tier system is a poor way to handle the deficit. There are other ways to help with the deficit by having area offices handle updates and support plans, and eliminiating APS and Maximus. Question 11, I feel cost containment, Quality of Care, and Education and communicaton are all important for APD to tackle .

**  COMMENT  **  I am afraid after making gains in Supported Living for persons with disabilities in the state of Florida, we are about to go backwards because the money spent is not being spent on direct care, but rather layers of bureaucracy. It's shameful !

**  COMMENT  **  I THINK IF YOU WANT TO CUT BACK MONEY LOOK AT THE PROVIDERS!! MAKE SURE THEY ARE GIVING QUALITY CARE NOT JUST A FREE RIDE!! START WITH THE RESPITE AND ASSISTED CARE GIVERS THEY MILK ALL THEY CAN FOR NOTHING IN RETURN!!

**  COMMENT  **  Take 50% of the money paid to DELMARVA and give the WSC raises. The majority of WSC to an excellent job and clients are being served well.

**  COMMENT  **   Social services for the disabled should be of the highest priority. This population can not care for themselves. Why should they and their families constantly be under stress to maintain basic services? I thought Medicaid Waiver was to help keep the disabled out of institutions. These new cuts will make it impossible fro many families to go on without the services they need. Building institutions will cost more money with worse care.

**  COMMENT  **  Afew of the questions I could have answered more than one way - for instance, I am a Direct Care Provider, Family Member and Advocacy group member.

**  COMMENT  **  For support coordinators, its over...

**  COMMENT  **  you need to cut much of your "red-tape" & allow the support coordinators to get the job done. allowing the APD to take over part of the data/info process is a big mistake. also the available funding is not sufficient for consumer services. what kind of a society reduces care services to the developmentally disabled? the propaganda from tallahassee is both moronic & disabling!

**  COMMENT  **  Thank you for allowing a survey that is actually touching on the topics that we are dealing with now. It is greatly appreciated!

**  COMMENT  **  If things keep going- there will be no more providers

**  COMMENT  **  In my experience, working with a large number of Support Coordinators, there is tremendous variability in the quality of service and accountability among them, with apparently limited recourse for providers and people served. Coming from a different state, where support coordinators worked out of a state departmental system, individual differences in competency were overseen and accountability was enforced. The people served received their services as intended, regardless of the initiative or responsiveness of their assigned support coordinator, because an effective supervisory system ensured quality and continuity. In this system, if you are lucky, you get a "good" support coordinator, but if you are not, you don't have much recourse.

**  COMMENT  **  Support coordinators need to be held accountable for there actions. The APD web page is not very user friendly and needs to be up dated better.

**  COMMENT  **  Please find a good leader for the Executive position at APD. We need a person who will keep focus what is important, the individuals and their services!

**  COMMENT  **  I am a support coordinator who has decided to resign after four years of service . The State of Florida has made several steps backwards and I no longer want to be a part of the madness.

**  COMMENT  **  Managed care how much worse can it be than what we currently have? The tiers are managed care in the worst way. When I talk with the staff at APD they don't know what's going on, so how do you expect us to know? I think support coordination should be an option. I think the free and natural resources are a cop out. The most important issue for APD to tackle needs to get rid of the programmatic staff , who continually make mistakes and have put us in a financial position that we are in now. APD needs a complete overhaul to gain some support in the legislature . Legislators will not listen because of all of the mistakes over the past several years.

**  COMMENT  **  I feel like decisions are made with no communication with families, for example, the tier system. Where did that come from? There may be families participating on planning committees or something, but I don't know about them or how to get information to or from them and even if their voices are taken seriously.

**  COMMENT  **  I think the tier system is unfair and not going to help those who in the future may need more help then they do now

**  COMMENT  **  It is absolutely terrible that providers are placed in a position of limiting services in order to make ends meet. Most of us are busy fundraising and telling our stories to raise money, and are not just sitting back waiting for the state to pick up the tab, but we - and our clients - are constantly threatened by ongoing cuts.

**  COMMENT  **  The priority for APD is to clean up its act. First and foremost they need a validated assessment system for consumers. Second, they need to weed out their excessive and ineffectual staff. Third, they need to practice cost containment within their bureauacracy and not project all cost cutting on the consumers they are supposed to serve and advocate for. No new or radical ideas here, just sound management priciples. Thanks

**  COMMENT  **  LESS PAPERWORK AND MORE TIME SPENT WITH CONSUMERS. THEY ARE OUR NUMBER ONE PRIORITY .

**  COMMENT  **  Client's rights are ignored by State workers and it seem that the only option is for a guardian to be appointed to prtect the rights of APD clients.

**  COMMENT  **  I think that the support coordinator and the care provider needs to come out more to see their client.

**  COMMENT  **  Tiers-services are being based on what $ is spent, not the services needed. So many of services have been eliminated for my child, RE: NRSS;lower rate for personal and companion care. Please leave our support coordinator ALONE! Paper work is redunant and way too much. Getting information is farily easy but so confusing and too many changes. I wrote and asked friends and neighbors to write to or legislators and felt this drive helped to not eliminate our support coordinator. Other comments : I would fire Carl Littlefield and get someone who understands our needs. Way too much $ spent on administrative services. Millons spent on on assessments tools. Leave $ for needed services. My child's files should not be evaluated by someone in Tallahassee without meeting her or knowing her. Our support coordinatior knows all of her needs. You are going to force good person to leave their positions so they can make a decent living. What a waste!

**  COMMENT  **  Yes but too lengthly to address here. Have suggested what I think is a better approach to control spending to APD, FASC and legislators but have only ever received back the typical "thanks for your input".

**  COMMENT  **  We cannot depend solely on government to take care of our sons, daughters, sisters , and brothers. We need to supplement through other avenues -- go back to a grassroots effort to help our community not just survive, but qualitatively GROW!

**  COMMENT  **  Getting consumers from Support Coordinators is very difficult for new providers. Some coordinators will only work with established providers. Consumers should be ASSIGNED to providers as they are to coordinators. This problem caused me to stop providing services because I could not get enough consumers to support myself.

**  COMMENT  **  I feel that every person should be able to receive the services that he or she deserves to maintain a healthy and happy life,just as these people who are trying to make life changing rules -- its all about the money .

**  COMMENT  **  Eliminate the constant changes, changes and more changes!! How in the world can we be efficient with regulations and procedures constantly changing? It truly is sickening! Thank You

**  COMMENT  **  The new process of submitting Cost Plans and addendum s is absolutely ineffective and proved to be not working at all. It represents an unnecessary duplication of workloads for both, Support coordinators and Central APD office. Paperwork is processed with great (2-3 months) delays and contains numerous mistakes in ABC (in quantity of units, unit rates, frequency and duration of service, etc.) that takes days to fix, thus delaying the approval of vital services for months. Even Support Coordination rate is often entered with mistakes. There's lack of communication between Support Coordinators and APD staff. It's complicated to trace the submitted documents even after they go to APS because Support Coordinators no longer are informed of assigned PSA numbers, are not informed when paperwork is being approved by APD and APS only provides them with the first initials of the clients. It is very unfair to change the status of the consumers who are assigned to Tier IV Waiver from HCBS to FSL Waiver. If State is so adamant about saving money and all the providers, especially Support coordinators, have suffered serious rate cuts, WHY the rate for Behavior Therapy service has never even been reduced??? Behavior therapy service is extremely overpriced, especially level I.

**  COMMENT  **  Getting help with problems and support hours for my son. I feel like I am fighting a hopeless battle with it all by my self. Suport cord. Never reponds. Companion is a better help to me.

**  COMMENT  **  Just keeping the consumers and providers informed - the changes are scary for everyone .

**  COMMENT  **  I actually am one of the people who have no vested interest as I am not a client or relative of a client. I am an advocate and a supporter of ACPD and the clients served by APD. I am also a former state employee. In my opinion, APD (formerly DD) program has been out of control for several years with waiting lists, budget deficits, etc. I think it is time for a full survey to be completed by experts outside the agency to determine what has caused the problems and to come up with the recommendations for changes. From what I have seen and heard from others, it appears that far too much is being spent on outside agencies such as Delmarva , etc. with APD staff sometimes even duplicating their duties. This even makes the support coordinators's jobs more difficult. Instead of coming up with resolutions , the program seems to merely implement additional staff and additional hoops for support coordinators and clients to jump through, as well as additional problems for Advocacy Center and advocates to attempt to pursue. It is time for a major over-haul and a strong look at what the rest of the world is doing! Perhaps a task force is needed....and it should include others besides the decision makers .

**  COMMENT  **  In my opinion the system is never going to be right. The people who are making these decisions will never understand what people with disabilities go through every day. All they see are words and numbers on paper. I challenge each person who is making the decisions to think about the following when making decisions: Imagine you are a quadriplegic and have limited services. Can you imagine what it's like having to depend on someone for everything? Can you understand how it feels to have to wait for four hours to use the bathroom? Do you know what it's like to sit in your own excrement for hours? Can you understand how disgusting that feels? Can you imagine having to ask a stranger to help you get a coke at the store? Imagine being hungry and not being able to get something to eat for yourself. Can you imagine what it's like to have your stomach growl and you cannot do anything about it? Can you understand what it's like to drool and not be able to wipe your own face ? Imagine what it's like to come home and not able to do anything until a staff person comes on duty. Can you understand what it's like to drop something on the street and you cannot pick it up? Imagine having to wait for a stranger to come by and then you have to ask that stranger to pick up the thing you dropped. Imagine being alone and have your nose itch and you cannot scratch it. Imagine what it' s like to be in one position for fourteen hours a day. These questions need to be considered when decisions are being made regarding the disabled. Please do not tell me that you understand because you truly cannot understand unless you are disabled. No one understands unless they are disabled or have taken care of a person with disabilities. Don't get me wrong - I love my life, but the system makes lives for people with disabilities tremendously more difficult than it already is. Manyvone Area 14

**  COMMENT  **  How terrible that the support coordinators made a deal with the providers that would benefit their profession and not the people they serve. Shame on you! You are supposed to be advocates! It is also clear that you are willing to deal with Amerigroup - just so you can keep your jobs! Time for you to stop thinking about yourself and start realizing it's about people with dd!!!!!!!!!!!!!!!!!!!! and Life or Death !

**  COMMENT  **  The Senate is poised to put APD in AHCA and turn the program over to managed care !

**  COMMENT  **  i BELIEVE APD IS OVERBURDENED. THIS LEADS TO A LACK OF CONSISTENCY BETWEEN THE MANAGED CARE PORTION OF THE SYSTEM AND LICENSING AND STAFFING PARTS OF THE SYSTEM LACK COMMUNICATION AND THEIR MISSIONS ARE OPPOSED. ONE IS SET UP FOR COST CONTAINMENT THE OTHER FOR QUALITY OF CARE AND MORE OFTEN THAN NOT THEY WORK AT OPPOSITE GOALS MAKING IT ALMOST IMPOSSIBLE FOR PROVIDERS. APD RARELY LISTENS TO THE NEEDS OF PROVIDERS . APD IS NOT SERVING THE WAITING LIST IN AN ADEQUATE MANNER. APD'S SYSTEMS ARE OUT OF DATE. APD HAS TO MANY ADMINISTRATORS. APD SHOULD BE RECOGNIZING NATIONALLY AND PROVEN TOOLS TO ASSES OUR CONSUMERS RATHER THAN A NEW TOOL THAT IS HOME GROWN.

**  COMMENT  **  How can this survey be for support coordinators. There is a question here that asks if you are willing to give up support coordination AND the word "TACKLE" is spelled wrong. You should add www.ffddnews.com

**  COMMENT  **  Gov. Bush's idea of choice with cost containment is a noble idea but since it is bureaucratic, I think much has to be considered without APD just doing what it wants without any accountability, transparency, and integrity.

**  COMMENT  **  Yes, I think the billing/payroll department is totally incompetent. There are always issues as to my employees not getting paid and it has ALWAYS been because of this office not getting job done . Also there is NO response to letters written to Sherry and Diana. TOTALLY INEPT OFFICE!!

**  COMMENT  **  Some of the questions are confusing,and it is difficult to interpret what you are asking. The choices of responses were too limited.

**  COMMENT  **  According to the new rules, I can't get away for more than 1/4 respite time for " a short vacation". Some people plan to take a break for 4 to 5 days (I can't). My son doesn't have enough days respite!

**  COMMENT  **  CDC plus is the answer

**  COMMENT  **  I have had to fight tooth and nail for every service we've needed for my daughter who has spina bifida. It is frustrating, confusing, upsetting and a long uphill battle to find out what she is entitled to and who supplies the service/product . I am completely worn out and don't know what to do. My support coordinator is wonderful, and she is always trying to help, but the red tape, and the fact that higher-ups do not know my daughter make the job nearly impossible for all of us . I am disgusted.

**  COMMENT  **  HOW TO MAKE CUSTOMERS OF THE SYSTEM UNDERSTAND THAT BY CHOOSING SERVICES THAT ARE NOT ABSOLUTELY N4ECESSARY TO THE WELL BEING OF THE CLIENT, THEY ARE KEEPING OTHERS WHO DESPERATLY NEED SOME VITAL SERVICES FROM RECEIVING THEM DUE TO BUDGET RESTRAINTS

**  COMMENT  **  I think support coordinators control too much of their clients' lives and aren't always aware of the programs out there that would be best for the client... They seem often to do what takes the least path of resistance, not what is best for their clients...need more training so they can be more effective in meeting the needs of their clients and advocating for them...not their parents, etc. They need to be more accountable and aware of self determination for all.

**  COMMENT  **  Tiers are going to hurt people that truly need services. It would be better to have someone look at the person's living situation and circumstances, available of family support, and specific disability needs rather than trying to lump people into a category based on the types of services they get. I also really wish that someone could manage to get physical therapy funding for adults who need maintenance therapy in a facility. I realize this would take legislative approval. I've got approval for physical therapy under Medwaiver, but there has not been a home therapist available for the past 18 months. The last physical therapist and his supervisor would not change my goals after 18 months despite the fact that new ones were needed and some had been reached. The therapist had little motivation to do his job. Even under the best conditions, the services that that can be provided in the home are limited because therapists cannot carry equipment with them that is normally found in a facility that really helps me. I am currently using Medicare/Medicaid for therapy but once improvements stop, my therapy will end since Medicare doesn't pay for maintenance therapy. It is ridiculous that I am continually being forced to regress to get physical therapy for spastic cerebral palsy (quadriplegia) along with severe back problems.I am 48 years old, and have experienced a reduction in function over the years. My ability to be independent is greatly enhanced with the right type of therapy and I find myself able to do more with less assistance. Ultimately, denial of physical therapy has at times landed me in hospital rehabilitation unit for a week at a time at a cost of $7,000+ because no one could figure how to enable me to get the maintenance therapy I need and regression to being bedridden and unable to transfer into a wheelchair was what it took to get insurance to cover physical therapy. No one I talked to in Medwaiver knew what ABC is. I'm not so sure that the new system being implemented with regard to billing and requesting services is going to help the clients. My support coordinator says it is impossible to find out the status of items/services requested and that everything is moving painfully slow. Billing hassles have run off some of my best personal care assistants over the years because they couldn't survive as a Medwaiver provider because of constant problems getting paid and being forced to wait months for a pay check. It never rarely clear to anyone why they weren't getting paid. Please note that often the billing paper work was submitted the same way twice, and was paid the second time with no changes being made to it. This points to a big problem in Tallahassee with computer operator error. There is more than too much paper work. It is unnecessarily time consuming for an aide to write down every move they make to document what they are doing when they are doing the same thing at every visit as long as the client is satisfied. This has detered good people from working for me because they aren't paid for doing the paper work. Cutting salaries for the lowest paid employees also results in getting some of the least capable people in the work force to work as personal care assistants and in-home support personnel. Many lack basic job skills, a good work ethic and common sense needed to deal with clients . I have had people not show up, break things, and nearly set my house on fire, and damage my van because they refuse to listen to me as a disabled client. Of course , I fired them. Luckily, I am bright, but I cringe to think some of these people are being sent out to deal with the mentally challenged population who will get taken advantage of. The state needs to find some other avenue of cutting funds rather than cutting services to DD clients. You get what you pay for. And if you cut medical services, most of us develop more serious medical problems and need more expensive medical care at an earlier age than we would if given appropriate care.

**  COMMENT  **  single mothers, with autistic children that have severe bahavioral issues, will be forced to institutionalise them, with all the coming cuts. it will cost the state more with these children in group homes, but, the group homes are being cut too . they will will not be able to get qualified staff with these extremely violent kids. it will break families apart and childrens lives are at stake.

**  COMMENT  **  I was a support coordinator for several years, then began working with a large provider . One of the questions, regarding the ABC (5), did not mention the problem Providers have with not being able to access ABC, even if it is just "read only." This would be a tremendous help for providers. SCs need a smaller caseload and more funding to do the job effectively. For both SCs and providers, much of the paperwork is unnecessary and the funding unrealistic for what is demanded.

**  COMMENT  **  In addition to adding more people to the waiver, I also feel that the options for providers and services should be expanded. In particular, better trained providers who are committed to helping clients would be a huge benefit.

**  COMMENT  **   Judge quality of CARE not paperwork. Some say 'if it was not recorded it was not done' I say ' much is recorded that is not done.'

**  COMMENT  **  The survey was limited as to the type of provider. There are many other providers of services to the consumers. It did not reach "everyone", therefore my answers were limited as much of it didn't apply to me.

**  COMMENT  **  It seems that florida's legislators and apd will never provide the appropriate services for adults and children with disabilities.

**  COMMENT  **  No, just keep on trying to make a difference in the lives of the people we serve and trying to find ways to do things that seems the econmy is making it so hard for everybody!

**  COMMENT  **  It is very difficult as an agency who has employees when we get cuts, can't cut back on our employee's wages, still have increases in costs of supplies, gas for training and working with clients with no reimbursement for mileage.

**  COMMENT  **  I AM A NEW PROVIDER FOR APD. AND WITH MUCH DISSAPPOINTMENT I HAVE YET TO GET ONE CLIENT . IF THE LIST IS SO GREAT , WHY NOT OPEN THE LIST SO CLIENTS CAN RECIEVE THE SERVICES THAT THEY NEED . WHEN YOU GO TO PROVDER ORIENTATION YOU ARE INFORMED THAT THERE ARE OVER 16,000 WAITING FOR SERVICES BUT WHAT THEY DON'T TELL YOU IS THE LIST IS FROZEN AND THERE ARE NO NEW REFERALS GOING OUT .

**  COMMENT  **  Why must cuts be made for the people providing services and those receiving services . There seems to be so much pie slicing that the providers and individuals are carrying the paycuts on their backs.

**  COMMENT  **  I think legislators don't consider the disabled, there are a lot of other ways to cut the budgets in Tallahasse.

**  COMMENT  **  If APD had the gatekeepers Maximus and APS contained costs initially we won't be here today. We never had this problem when APD was reviewing costs and plans. What happen? Somebody wasn't watching and it was blamed on the WSC? Get the cost under control and we can rebuild the system to make it work for everyone.

**  COMMENT  **  get the people the services that they are entitled to before more families break up.

**  COMMENT  **   The APD has already made up its mind what they are going to do regarding the Tier System in order to make the transition to Managed care. Once the Tier system is in place, the Independent Providers and smaller Agencies will not be able to stay afloat. By the way, 'Managed Care' is a system set up to specifically benefit the Shareholders and not the persons ( Consumers ) for whom they serve. There is no getting around that fact. Our best hope lies in the filing by the Advocacy group to stop the process of converting to the Tiers. As a WSC , the Tier system will actually simplify my job greatly, while at the same time deny needed services to persons with developmental disabilities. I am against the Tier system for the sake of the Consumers; if I was NOT on the side of the Consumers , I would be all for the Tier system. One more thing, theis whole 'Budget Cut ' process would not have been necessary if the APD had not mismanaged the funding in the first place. APD is quick to state the WSC's are requesting services that are not medically necessary. I am reminding you that no WSC throughout the state has approved any DD Waiver services. This approval process was done via ( both subcontracted under APD ) APS Healthcare and PSA Maximux. The WSC's job is to submit to APS Healthcare or PSA Maximus the information regarding a consumer's situation . APS Healthcare / PSA MAximus then evaluate the information and make a decision to either approve or Deny the funding. IF the WSC did not make a strong case to justify 'Medical Necessity', the funding would not have been approved.

**  COMMENT  **  This will go in the pile with all the other suggestions that have been ignored by APD.

**  COMMENT  **  Some of us have harder situations and people than others. We have no one that goes with family anywhere? (l person 2 days a year)! We had one person with no other services than us for years!!! Tough! Why and how do we fit in same pay ranges sometimes with providers that have their people go for holidays, weekends , etc.!! Life seems unfair, especially when you are trying to do everything you must do and have many health issues on top. I am thoroughly discusted with hearing nothing except pay cuts when we have worked so hard to help our people . many times we have worked 18-hrs a day!! Never have we been over paid - just we never can do enough!! Never good enough! Most of the people telling you what to do - have never done it, especially every day of the year! We hate politics - these are people's lives and our life too!! What happened to person centered ?? I don't think they ever got there!!

**  COMMENT  **  I feel that SPD has only the muddy water even muddier, instead of correct problems . They do not have the skills needed to make the required corrections and are not open tolist to people out in the field who maybe able to see things from a different point of veiw. I think they are only concerned with keep thier jobs.

**  COMMENT  **  On # 14, I am also a Local Advocacy Council member.

**  COMMENT  **  From my understanding the APD is supposed to be there to guide providers and give them information on issues they might not understand. I feel that they do a terrible job at this. The persons that work in my distriict are very hard to get ahold of and if you are lucky enough to get ahold of them they usually don't even know what they are talking about. I usually get a different answer from several people in the same office. Also they seem to be really put out and bothered when you call to ask questions or to clarify information. But when you make a mistake on the job they are the first ones on the phone to you and they will call 5 or 6 times in one day and want to hold you very accountable. Well I feel that if they offered more thourough training and were more assesable to providers there wouldn't be so many mistakes made by providers. I also feel that they do not do a good enough job of making sure there are providers out there that are providing quality of care. I know of atleast 5 people that are providing Supported Living Services that are not qualified to provide that service. They work for a company that is allowed to provide the service, but the company is hiring unqualified persons to do the job (people with no college education what so ever!) This is an high dollar service that the clients deserve to have the qualified personal working with them. I think if the APD worked on getting rid of the bad apples that are taking advantage of the system and our clients the whole program would work alot better.

**  COMMENT  **  I suggest that APD is administratively top heavy and cost cutting should be done there first before affecting the consumers served by reducing services available or cutting provider rates. Let us remember, one gets what one pays for!" You pay crap and you get crap in return. Unfortunately, the persons who end up with most of the crap is the consumers who are supposedly served through these waiver programs. Quality of services will be affected by the rates cuts. I personally know that providers will have to provide services on a 1:2or 1:3 ratio for the services that allow such. Providers who stive for Best Practices and provide services on a 1:1 ratio no longer will have that option due to the rates being so low and the cost of quality Direct Care Professional Staff is at a premium. No one is willing to wipe butts for much less than 10.00 per hour and now with PCA rates going to 15.00 per hour for the agancy, NO ONE WILL BE ABLE TO PAY MORE THAN 10.00 per hour and there is no room for raises. How long will quality Direct Care Professionals remain in these positions. The cycle of musical providers begins. Managed Care is not the answer as we all know the quality of care with this in the medicine. It simply does not work and limits choice even further than it is presently limited . I remember the waiver of the 1990's in Florida. Yes, there were budget cruches ; however, they never affected the quality of services. Local APD offices are superfluous . Why do we need so many persons in a local office? Why can't things be handled by the private sector? It seems it works best when the state has little or nothing to do with the process.

**  COMMENT  **  My Coordinator, and care provider are WONDERFUL.

**  COMMENT  **  I have a daughter with Down Syndrome. I believe that our legislators are doing a great disservice to the people of Florida who have developmental disabilities. They obviously have very little understanding of the needs of our population and I feel sad for the consequences that will soon follow their decisions.

**  COMMENT  **  We as providers or caregivers would loose our license if we neglected our clients , so why is the state able to do so? What the state is doing is neglecting the needs of the indivuals needing service and those on the waiting list.

**  COMMENT  **  none

**  COMMENT  **  Values of those making decisions are pushed onto families/consumers, and providers are unrealistically held accountable for ensuring things happen. Services should make it easier for families to keep individuals at home. Most of us did not ask for a person with disabilities and it should not have to be a life-long burden. We should be able to get the support we need to ensure our family member is living a quality life according to what our family member values. Saying that personal care can not take place in the community is perposterous!! My son is unable to go out into the community without others keeping him safe, taking him to the bathroom , wiping his butt, nose and chin, and without being fed. His needs go well beyond "companion" and to be stuck at home day in and day out while we work, simply because the Waiver will not pay for personal care in the community is not a quality life . The new medication regulations make it virtually impossible for us to get a weekend of respite. We can not go out of town and leave our son in respite because we need to stay close by so we can go and give meds.Our son has a feeding tube and needs medication a minimum of twice a day. How much sense does it make to pay for a nurse to come out and do a two-minute process when, in actuality, it is safer to give meds through a tube than it is for many to risk choking on oral meds. Also, he has a rectal medication for when he has frequent seizures. It has been successful at keeping him out of the ER for several years. Prior to that, we ended up in the ER at least a couple of times a year, and at least once a year he was hospitalized. Now, with these new regulations, if a provider needs to use this medication, they are mandated to call the ambulance! What a waste of money!!

**  COMMENT  **  We need support coordinators to support people with DD. Stop talking to Jay K about how you can support managed care. It will be so bad for ALL people with DD . VERY BAD!!!!!!

**  COMMENT  **  we need to be one voice

**  COMMENT  **  people over 21 years of age and the issues they face!

**  COMMENT  **  dont use natural suppoorts because I dont have family that is involved in my every day life. it doesnot count when they live out of state or they are just to busy this is why i have pd supports to assist me in every day living and alot of the people i know have aging family and they would not be able to assist me and when my frineds get older so do the parents and this does not live us with natural supports and alot of the people in the community do not want to be bother again this is why i am on the waiver

**  COMMENT  **  My brother is apart of the CDC program and I love it. I have control of our his money is used. I'm so happy that APD have taken control of the payroll problems over the years and I hope that they continue to span it out to the bigger waivers . I hear some of the probelm from my wonder support coordinator and yes if you write to your state reps/key people in APD and local contacts yor problem and concerns will be addressed and most likely solved. Job well done. thanks.

**  COMMENT  **  The Florida legislature is clueless about how hard this cut in funding will make it for people with disabilities. They may as well take a gun to these peoples heads and shoot them quickly instead of SLOWLY killing them by taking away MEDICALLY NECESSARY services or consumable supplies. This proposed TIER system is not going to work!!!

**  COMMENT  **  Before making changes to the waiver, the state HAS GOT to listen to the people in "the trenches". For the most part, we have really good ideas on how to save money , make the waiver a more effective, quality program and make it work better for all concerned!

**  COMMENT  **  Tiers are a gimmick. I've given up hope on the political level. Seizing financial power is the only hope. Writing to legislators or to APD is like asking an alligator to not put his elbow on the table when he's eating you. Information about services is always handed out after it's too late. APD should fight the crooks in Tallahassee and demand full services for everybody who deserves it and who is not scamming the system. The paperwork Support Coordinators must deal with is deliberately & directly oppressive to the client and "natural resources" is an insult ! Trading my Support Coordinator for services would only give the politicians & "the system" complete control.

**  COMMENT  **  Our individuals with DD are most CERTAINLY the ones who DO AND WILL suffer from cuts. I have asked and continue to ask...WHY DELMARVA...WHY APS....WHY MAXIMUS . And throw in WHY are so many support coordinators leaving this business????? There is ABSOLUTELY no support from district or state !!!!!!!!!!!!

**  COMMENT  **  I Love SupportCoordinators.com & WaiverProvider.com Thank you so much for helping us all get information that is so hard to find. If it was not you the websites I would be in the dark.

**  COMMENT  **  The APD needs a director that will stand up for the developmentally disabled, their families, and providers.

**  COMMENT  **  All children with medical disabilities should be on the waiver. Parents that want to take care of their disabled child should have the funding . To be at home or in a loving home is better then having a social worker talk parents into putting them in a nursing home. Places like that lie about the care that they say the child will receive. The children only have a cold , nonloving exsistence. The parents are not told the truth. No one holds the children ,no one wants to here their cries , they are sedated . This makes them sleep. Children that cry need to be loved not placed into a nursing home,the social workers should be sensitive to child and families. What the social worker does not tell the family, when placed into a nursing home the child looses every financial means of funding ,LIKE THE WAVIER-This all goes away. Why do nursing homes and social workers neglect to explain all the details ?

**  COMMENT  **  delmarva is overpaid apd should do the job!!

**  COMMENT  **  I think too much time is spent on peoples salaries and not on what is being cut from the consumers. I know a consumer who has 2 families living there...he has 13 hours a day 7 days a week....he is not aloud to leave the house...no extra care needed but bathing (he feeds himself but they won'tlet him. WHY R THEY LETTING THIS HAPPEN? The family has the staff do their laundry and clean there house and cook for them first! Why????????????? But another client lost massage months before itwas cut because the WSC was to lazy todo the paperwork sohe paid $50 a week of his own money because he needed it.

**  COMMENT  **  If you really care about persons with disabilities, stop treating Agency for People with Disabilities like they are the “BAD agency” and get real results. The former govenor started this trouble!!!! 1. Instead of cutting APD---Put EVERY state employee (NOT JUST APD) on OPS. If they don’t work that day/ week they don’t get paid 2. Secondly, have every MEMBER that works in the Capitol GIVE ten percent back into the treasure of they gross income for 2007. If it wasn’t for the people of Florida you might not have a job. These two steps won’t put a stop to all the problems. But it will put a dent in it. I’m a person with a disability and I CAN NOT get a job because of the Governor and his “BUDGET CUTS EVERYWHERE”. I am embarassed to be living here with all this governor has done that will hurt PWD!!!!!!!!!!! Thank you, for even reading this If I can be of service to you please reply to this e-mail.Sincerely, Wynona Voter and Self-Advocate

**  COMMENT  **  District IV Group Home Placement Coordinator ( Angela)and Group Home Monitor Supv. ( Denise) are out of control and demonstrate traits of ' power trips'. I have personally been in the midst of their unprofessional behavior as well as other group home agencies, with little or no help from their supervisors . The Districts should not be given more authority/power over providers, because agency owners are speaking amongst themselves about closing their doors permanently , which will hurt the consumer and their families to which we are here to serve!

**  COMMENT  **  Start telling the truth about why there is such a large budget deficit. Treat people with disabilities and give them the quality services they need to become productive members of society- -heirarchy of needs-people can't focus on work and outreach when they can't get services to bath or have a companion. No one should have to choose between work and a social/recreatioal life. Pay providers realistic wages to retain and cut down on retraining money wastes. Ruduce duplicate and expensive documentation and join the 21st century florida!!!! Update your tecnology so services can be expedited mor efficiently.Reduce executives life pensions & perks and use the money for consumer services. Weed out the lazy consumers and reward the ones that work and contribute to society. Stop penalizing people with disabilities for tryng to work-the ss trial work periods are not working!!!! Help those who try and help themselves. Cut off the helpless hopeless lazy straglers. Teach & educate people for work ethics and education themselves. All state officials reduce their pay & retirement funds by 5-10% and see how that helps the consumers and front line workers. The state of FL needs to recruit GOOD professionals to work with this population to truly help them by paying them a living wage-just like teachers. Regulate banking institutions and implement FL financial regulations to help our state & country. People with disabilities need a democratic society OR the republicans to mentor them on how to make money. Stop being so greedy and help your children & future NOW. They are not asking for BMW's-only supported living services and personal care assistance. Put them to work-offer bigger tax breaks andtrain those who want it-don't leavit up to uneducated support coordinators who can barely survive on the low wages they are paid. You are lucky to have educated committed providers (most) and you need to retain them. I have a masters degree and 20+ years experience . I am a nationally certified rehabilition counselor. I am quitting because I deserve better, as do my consumers I can't even make my visits with a 35% pay decrease with the price of gas & supples. Walk the walk and stop the lip service. All the retiress are now collecting their huge pesions and perks is what got us into this situation in the first place. Stop swiching incompetent contract providers every3 -4 years. Employ contactors that can actually make a difference. Invest in Florida 's future of people first and make us leaders in the field. You know what to do. Consumers with disabilites cannot even have an outside companion if they decide to attend a sub wage workshop 30 hours per week. So who'watching the group homes and protecting consumers on a daily basis. End the war and help the US and its people. COMMON SENCE. Hire me to write grants to help our state. Accept that everyone has somthing to offer given the right tools to work with. Diabilities are not liabilities -they arelearning differently and can be taught to self maintain withproper supports and services. Invest in the future of Florida by people who will hire the disabled .Give them realistic tax breaks and incentives. Make supervised prisoners help othes by paying back to society. There is so much that can be don if yu just spend the time to be creative and try new strategies.the old ones aren't working. Look at the people who really care and are committed rather than big businessw/incentives . You may be surprised.Call me when you're ready to get creative and stop wating money on meiocre services. We, the front line people can tell you who is exploiting the systems andwho wants to change.You need tostart to listen to those of us who know and not the lawmakers that don't know and don't care what is happening in the real world. GoodLuck

**  COMMENT  **  I want as many people as possible to be served under the waiver. I feel that cases need to be reviewed and individuals with alot of family support and are high functioning should have some of their services cut and the families that truly need services for a low functioning individual should have more services. I think the tier system is a step in the right direction.

**  COMMENT  **  Hope this survey would make a difference toward everything that is coming down across the board.

**  COMMENT  **   Please stop to many changes in one time that impossible to make it happen makes confusion. I thought the main purpose of medwaiver is to let the care and service to client by their family/direct care provider simple that they will be not be institutionalized. But the way it changing clients will be treated like institutionalized with all rules and changes they want for family member,direct care provider and coordinator.

**  COMMENT  **  Too much paperwork. Cutting that would help with costs. Cut Delmara..they take a huge ton of money, to intude into what we are doing.

**  COMMENT  **  Cost containment needs to also include doing away with Delmarva and Maximus and placing those services back to APD Districts which already have the staff to provide monitoring and costs. This will elimenate the millions already spent with these two entities.

**  COMMENT  **  The waiting list must be addressed. The state needs to prioritize the list and start putting adults at the top of the list. All individuals under 22 must be served well by their schools - it is the law. What is happening here is a scandal. Everyone is discussing the tiers, but no one is even mentioning the waiting list - the forgotten step child.

**  COMMENT  **  It think the poeple in high paying jobs at state agencies should be spending less money on overtime and expense accounts and that money should go into more services to clients. While state officals FLY around the state instead of video training and telephone meetings clients and their families are pinching pennies to pay for necessary services and doing without.

**  COMMENT  **  It a shame that the support coordinator never has a answer or try to help. It's always a no answer or there are no service to help you. You can never get an direction to go and get what you need.

**  COMMENT  **  I agree that providers and WSCs should have a type of survey to ensure they are doing what they are paid for, but Delmarva has not been productive. We were "consulted with" by Delmarva last October and I have not received a report as of this date . I know that we have worked hard to correct identified issues but I also know that there are some providers who could care less so what are they doing to resolve issues. When AHCA surveys ICFs they hold people and companies accountable to correct issues/problems which does improve the quality of services. Also who is monitoring all of us providers routinely, each district has different ideas of how they want providers to document services, SL rules, standards- so a provider who works with many different districts must taylor how they provide services based on the desire and whim of each district. This gets very confusing and where does that leave the individual- they can easily become second to politics/policies/ and paperwork if each provider is not very careful to ensure they remain the focus and everything else is important but really supports the individual. SL medication rules are forcing SLCs to look at supported living as a group home and not as an individual living on their own with support. If the waiver program wants to keep placing rules in place which encompass every aspect of the individual why don't they authorize more ICFs and pay like an ICF so that providers can afford to have the staff to be able to complete all the requirments set forth.

**  COMMENT  **  This is oversimplistic-even Delmarva discourages yes or no answers for satisfaction surveys. This would lead to misinterpreted data and allow for sensationalized use. Example: #15: Heard by whom-legislators and APD are two seperate entities- with two distinct hearing abilities. #13, 12, 3 are indicators of the involvement of the person-not a relevant or factualpiece of info. In order to be of any value this is not analytical enough, and I can only think of the slam books that used to be passed in the halls in JR. HIGH (I did not respond to those either)

**  COMMENT  **  I think that there needs to be more education about resources and the wavier program . I don't believe in the tier program, I believe it is going to hurt more clients then help them obtain the help that they need to live a fulfilled life.

**  COMMENT  **  Please use your resources to gather support for the appointment of Jim F (McDonald's Traning Center)to replace Jane J. Jim has extensive experience in turning around problematic programs (D-6 and D-13)with the vision and fiscal underestanding to finally get the APD program on the righ course. I've been in the field for 30 years and have found that Jim is the only person in the State of Florida that can manage this program. He is able to work with all provider groups , has outstanding organizational and planning skills and has demonstrated his expertise with the Pilot program in D-13 in 1999-2001 that should have been the model for the whole State of Florida. Politics derailed his appointment to the top APD position .Jim was one of three finalist for the top APD position before Mr. Regeir was appointed secretary and brought in Shelly B a nice person with limited experience in the DD waiver and limited skills with fical issues. You know the rest of the story. Please help. Bob , People Systems

**  COMMENT  **  It is time that the state legislature realized that they have a moral obligation to those who can not help themselves and fully fund services to those in need. Encouraging families to provide natural supports at the cost of their own health and well being is a travesty and should never be how the state relieves it's own obligation to the citizens in need. Start doing the right thing by the citizens of the state instead of enriching yourselves, we've had too many people who have become rich at the expense of the helpless and needy.

**  COMMENT  **  I'm concerned about persons on wait list receiving nothing and waiting six to eight years for services.

**  COMMENT  **  I have not been a WSC long and learning the various forms to use each time I submit a SP is VERY confusing and frustrating. I am told to send in forms one time and the next time I don't need to send in the form??? I feel like an idiot most of the time and I know for a fact I am capable. I want more than anything to do a good job for the people I serve and will keep asking questions even though I may ask the same question again and again. Please help us that are truly in this to help and not just for the $$$.

**  COMMENT  **  Utilisation of policies and procedures already in place are seldom critiqued. Stop gap measures, pushed by unknowledgeable persons, allows legislators to take negative actions towards those Develop- mental services is supposed to help. Support coordinators are not the answer to the current fiscal crisis as they are not helpful with needed data the legislators can see. Only knowledgeable providers, working with an indisciplinary team addressing the individual needs of those we serve, will convince the lawmakers how crucial each of our services are. As is now, this survey , others, portends to extoll the necessity of support coordination. By now, you should realize how fruitless. Together we can."

**  COMMENT  **  Due to autism risen and other disabilities, a lot of families still do not have any help, or ver little help. CDCt is a great program.

**  COMMENT  **  Need a leader.

**  COMMENT  **  Updating ABC CP screens should be returned to SCs while APD approves them. Would increase accuracy and timeliness. Amendment form takes me more time to do then to update ABC, then APD has to input info again into ABC, two people doing 1 task . Tiers should only affect less than 5% but some districts affects 30% OF consumers in addition to 5.5% provider rate cuts. SCs are rapidly quitting all over the state due these poorly thought out chgs. Quality will be affected which in turn will cause health and safety to be decreased.

**  COMMENT  **  There should be statewide performance measures to monitor and assure some level of quality in the APD Area Offices. They all operate differently and with varying levels of proficiency.

**  COMMENT  **  thank you!

**  COMMENT  **  Thanks for doing this survey.

**  COMMENT  **  I am ashamed of my State of Florida who continues to trim or cut services for its most vulnerable citizens under the guise of budget control. I am ashamed of me who voted for Charlie believing he would make a difference, and his underlings who continue to say they are working for the greater good, while undermining the efforts of the front line advocates who truly believe that we are making a difference. A good support coordinator is a blessing for our consumers and we would not have independent living without them. The powers that be can cut funding, lower services and create tiers upon tiers, but advocates like myself will never go away. This special population is just too important to abandon. Thank you for asking for my opinion. MG

**  COMMENT  **  Thank you very much for taking your time in developing this excellent survey. I emailed a letter last week (to APD Central and District office) expressing my concerns with the current Cost Plan submission procedure but I have not receive any response . I will email you the letter as well.

**  COMMENT  **  none

**  COMMENT  **  My son has been on the list for three years and has not recieved any services from Med Waiver.

**  COMMENT  **  Most of the families I speak with, say that they never see the support coordinator and do not know what their job is supposed to be. Many families could function as the service coordinator if given the chance (like CDC). Make it an option based on individual choice. As providers, I feel we spend more time on documentation than actually working with the clients. If you provide one hour of service, plan on one hour of paperwork.

**  COMMENT  **  I actually went to my state representative personally and I got immediate result for services for one of my client. Later, after the support plan, the services were cut drastically by APD.

**  COMMENT  **  Personally, I think the APD/Support Coordinator system needs an overhaul.

**  COMMENT  **  I truly wish that the whole APD regions would work together as a team. For example , what goes for District 7 goes for District 14 etc. Most of these people in these offices are very bias and a lot of the time I do not believe that APD recipient ,Providers,and support coordinators are been treated fairly. The people we serves supposedly have rights, but sometimes I have to wander if they get the chance to exercise them. For example, an individual reguest to live in Winter Haven, but the support coordinator believes that the distance is too, far, so quest what? That individual has to take what APD placement coordinator refer and the support coordinator agrees to. Something needs to be done.

**  COMMENT  **  I am a provider and I do not feel this survey was put together very well. I seemed to me that you were looking for specific answers by the way the questions were asked.

**  COMMENT  **  The rate reductions and the increased requirements and unfunded mandates are inconsistent with what can reasoanbly be accomplished. The legislature, Governor and APD is putting the entire system in jeopardy ----if it continutes there will be tragedies .

**  COMMENT  **  Question # 12 Thanks to our support coordinator all my questions get answered. Question # 13 We have not given up hope, but it's very frustrating. We don't know from one day to the next whats up with your agency.

**  COMMENT  **  It appears to me that the state of FL is effecting change for changes sake alone ; form always over substance. I frequently wonder if the powers-that-be have ever met an individual with a developmental disability. So much is so out of line with reality. The idea of not being able to submit amendments to a cost plan during a given year could end up costing an individual their life. Containing cost is imperative but why must it come out of truly needed services. Why is Delmarva even necessary, for example? How many monitoring agencies does it take to ensure against abuse of the system by providers? In addition, what are all the imaginative people who make up the items and categories contained within the Monitoring Tools paid to think up things like "Collaborative Outcomes" "internal and external barriers which impact effectiveness" on and on and on. Very little of which does anything productive or instructive in my experience. Perhaps I have just missed the point somewhere along the way.

**  COMMENT  **  Some clients have way too many hours and don't use them, others need more hours and can't get them, no rhyme or reason. Some services seem like a big waste of money for some client's like speech for client who hasn't spoken ever, job coaching for a client who has been stable for years at the same job, dental for someone who has no teeth.

**  COMMENT  **  I would like to see more focus on how to improve the life style of the consumers . I see that every day the services that they recieve is been threat to desapear in anear future. Parents are desperated not knowing what is going to happen. we need to know that our population in need will be served with the tax money we contributed every year.

**  COMMENT  **  This should not happen. The consumers will suffer these cuts in services.

**  COMMENT  **  EVERYONE'S CIRCUMSTANCES IS DIFFERENT AND THE CHANGES WITH THE LAWS THAT PERTAIN TO MEDICADE AND MED WAIVER ARE HARMING THOSE IN NEED, FOR INSTANCE MAKING PCA A MEDICADE PLAN IS UNBELIEVEABLE DUE TO NO PEOPLE TO PROVIDE. THE CUT BACKS ON CHILDREN WITH DISABILITIES LIVING AT HOME RATHER THAN IN A GROUP HOME IS AN OUTRAGE!!! YOU WILL PAY MORE FOR THEM TO GO INTO A HOME WHERE THERE SAFETY IS NOT SO GUARANTEED RATHER THAN TO SAVE THE STATE A LOT MORE MONEY AND GIVE THE FAMILYS A LITTLE MORE HELP AT HOME.... THIS IS CRAZY AND OBVIOUSLY THE PEOPLE MAKING THESE DECISIONS DONT HAVE KIDS OR FAMILY LIKE THIS.......

**  COMMENT  **  The rate of pay for independent providers is extremly low considering the excessive amount of paper work, training, meetings and desk reviews we have to do without being paid. Also, we get no benefits in the form of medical or time off with pay based on the hours of service provided. I feel there is a lot of redundencies that take pay away from those who provide the service and the support us such as the support coordinators and Delmarva. It should be the Support Coordinator or Delmarva who oversees all areas of the serivce I provide. By having both companies , it is raising the Medicare cost to provide service to those who need it in our community.

**  COMMENT  **  Providers need a voice and need to have meetings so they can find out what is going on not just second had though coordinators.

**  COMMENT  **  We need our hours back for our people with in home supports! Most all of these people have special needs and deserve 40 hours per month. I often lose money by continuing to take care of their needs.

**  COMMENT  **  its imperative that the level of care continue as in the past since my particular individual has progressed very favorable and with hope shall continue with more progress.

**  COMMENT  **  none

**  COMMENT  **  Many questions can not be answered accurately because they need to be expanded on . For instance, I am not just a family member. I was heard possibly up to a point , but this legislature is very difficult and so repetitious even with input.

**  COMMENT  **  Not at this time

**  COMMENT  **  Most providers are out there trying to do a great job for less and less money. APD should be on our side and the side of the people we serve.

**  COMMENT  **  MAKE LEGISLATORS COME AND VISIT WITH FAMILY AND LIVE WITH THEM FOR A PERIOD OF 10 HRS ONE DAY TO SEE WHY THEY ARE WRONG IN WHAT THEY ARE DOING. LIVE IN MY SHOES FOR 1 DYS PLEASE. WHY DID CONSUMERS AND WSC AND PROVIDERS TAKE CUT IN PAY AND SERVICES AND LEGISLATORS GOT PAY RAISES? PUT SEVERAL LEGISLATORS IN WHEELCHAIRS OR BLIND FOLDED AND WATCH HOW THEY DEAL WITH THE DISABILITY.

**  COMMENT  **  This survey ignores how APD pays outside consultants for assessments that are not used, plus Maximus and Delmarva, vs. offering help to people who desparately need basic services.

**  COMMENT  **  what is going on with apd the less fortunate are getting a bad deal

**  COMMENT  **  When changes are made they are not communicated accurately or in a timely manner . Key representatives of APD are simply not well informed themselves. After changes are made they are often retroactive without prior notice. July should be a nightmare with all the changes planned. More providers will leave, and quality of services will suffer if APD doesn't get it's act toether soon.

**  COMMENT  **  I am hoping that with the new company I will be able to apply for my own services . ACS was not easy at all and I had to hire someone to do it for me. I take care a one child and he is getting older now. I did this favor for his parents but I don't think I would do it again unless the paper work gets easier.

**  COMMENT  **  WE CAN NOT GO BACK TI IDS/OR ANY INSTUTIONAL SETTINGS.

**  COMMENT  **  Plenty of comments. I suggest that Gov. Crist get as involved with the matters of the disabled and be as involved as Gov. Jeb Bush was. Gov. Crist needs to understand more about the citizens of his State who are trying to become paying and voting citizens. Some of the disabled want to pay their own way by working and giving back what they are earning but cannot do so on the funding that now exists because of Gov. Crist's lack of interest and habitual budget cuts on the disabled. Don 't try writing to him about it because you will only get a form letter saying that he will get back to you or a person from his office will write and you can tell that he/she hasn't a clue what they are talking about. I believe that we who are involved with the disabled are up against a brick wall with Gov. Crist. He is surely not a people's governor. He is only out for his own fame and glory. Right now he is trying to hard to become the vice president of this country instead of focusing on being a good governor for Florida. Please remember this when it comes time to vote for a new governor. The last time I spoke with Gov. Crist he blamed all of these cuts on the Federal Government. He didn't know that I was well aware of the goings on and that APD and ACHA are my main sources when I need information and the recommendations for these cuts came from the State Government not the Federal Government. The Federal Government only gets feed-back from the State officials and votes on it after they get the recommendation from the State. Gov. Crist should be made aware that he is not dealing with dummies when it comes to fighting with the advocates of the disabled. We are all involved together and we will not give up. At least I won't......... I would like to know where did the State get the money for the people who are doing the newly arranged accessments? Why are they paying for firms like Maximus and DelMarva? Do we really need all of these watchdogs for the State? Maybe some of that funding should be cut so that we could have it for the needy. I've been to Tallahassee several times and I am willing to go again if it gets enough media attention about the issues that are strangling our disabled. Who knows, maybe ex-governor Jeb Bush would be willing to help us. That would surely get some media attention......

**  COMMENT  **  I think that if service providers had focused on results rather than "spending time " the waiver, as a whole, may have been considered a sucessful program; not just a few select areas such as SEC and SLC. I am sorry to see so many changes but often shaking things up a bit (or a lot!) results in a different and more functional view. I have heard a bit about managed care but only how it will affect supports coordinators, not how it will affect those who use waiver services and service providers. sometimes change isn't pretty, or things dont have to look good to be working.

**  COMMENT  **  I think that the more the agency thinks they save. In reality you are wasting more money. Cut down on the new programs, keep the old programs in place, stop changing the rules and hiring new people to figure out what it is that they are doing or supposed to be doing. you would be surprised on the amount of money you could save. You are causing enough chaos in a situation, where chaos should be avoided .

**  COMMENT  **  Yes, the question regarding the Teir was not elaborate. I don't think it is fair to force WSC to cut about $3000 in order for the individual to be placed in a specific Teir. Especially, when all the services being rendered are a necessity. I have many Individuals that just receive the needed services like Mentor Res. Hab hours , ADT 5 days a week, transportation to and from ADT 5 days a week, dental services , and consumable medical supplies in the form of Pull ups. What is suppose to be reduced? Should Individual's meaning full activities be reduced? Leaving the individual room to be mischievious. I beleive the entire Tier and their caps should be re-evaluated to fit the individual. Everyone is trained that all care and services are PERSON CENTERED, BUT the state is going to ask us to cut their services in order to fit into their tier. Tier's should be set according to each individual 's needs. I understand there are many individuals on a waiting list and the concept of the "tier" would free up funds, but would only provide mediocre services. I believe each tier should be taylored to fit each individual need. This would still free up funds in order that other individuals can be added to the HCBS Waiver and continue to be person centered.

**  COMMENT  **  APD created caos at the local level. They operate on trial by error without looking at who is affected. The agency administraors created the deficit and then used the support coordinators as their scapegoats. As a support coordinator I never wrote a budget for the agency nor made projections, they did, they are the ones to carry the blame. Now Jane Johnson say that she did not want this changes so those of the like of Linda Mabile et al are the ones to blame. They never come out of their offices to see the reality out here.

**  COMMENT  **  when budgets get tight the handicapped are the first ones hurt. this shows that the state actually does look down on them as second class citizens.

**  COMMENT  **  Too much buracracy; too much paperwork; misinformation from APD; too much local interpretation and not applying best practices; over regulated; under funded, etc ...

**  COMMENT  **  The issue of how the tiers and how the state of Florida's legislation is trying to fit s Clients level of needs into a very unrealistic budget. Their playing with human beings lives and until someone dies because of the provider pay cuts which is going to impact the level of care to APD clients and a family steps up and sues the state due to their implementation of the tiers.

**  COMMENT  **  i nnnd work. thank you,

**  COMMENT  **  In Jane Johnsons interview with you she said "consider the source" when getting information about rules...the numbers, or anything else that is the responsibility of APD to report. I especially know about suncoast ... that is paramount... Certain people in APD and Delmarva Maximus etc.... like to pretend there are rules that don't really exist (Margaret was a master at this but they all do it), just to support what they are saying at a given moment... these people should be shot ...or horse whipped at the very least. They are decietful manipulating idnividuals who lie at the drop of a hat just to control a situation and support their position . Those are the people that Jane Johnson was talking about. I personally have witnessed Maximus do it in a court hearing....Delmarva at a review, refusing to apologize when caught....They've been doing it for years..and I can document it for you if you'd like.... Like if APD were to tell desperate people coming in to their office for help that no waiver exists, and then "they go away" (in quiet desperation but still needing help none the less)...why don't they try that? It happend for so long in this district that I know of, that it distorted the numbers to the legislators about just how many pepole there were out there that really needed help.. this act directly influenced the amount of money they expected to need and asked congress for... and it distorted everything... first lets be honest about how many people out there need help from the waiver... then lets make sure the legislators know about it,,,, then get the $$$$$$$.... they need to find the funds to fund this program with an accurate vision of who is out there and how much money it is r e a l l y going to take to serve this population.....This is not a popular solution / belief, because legislators don't want to raise taxes or spend money, Nobody wants to be the bearer of this b a d n e w s...They are asking themselves, how can the budget have been soooo far off from the need over all these years.... have more cahllenged folks been borne than ever before?? NO...they were telling them to go away....Diane told me that herself...she said "we just can't help EVERYBODY"...were her exact words... yes...we have to help everybody ...that is what I said then and it is what I say today...people who cannot help themselves must be helped....???? but until that problem is solved, we can rob Peter to pay Paul all we want,,,, there will be no answer.... You can talk all day about how to better the system to make the money stretch... and you can spend large amounts (delmarva etc) trying to catch the crooks (you don't really think this is to improve service to the consumer do you?)..the fact is, no system will ever be perfect, you will never completely stop the fraud that exists, crooks will always find a way...if you spend 20 million dollars to find the crooks that cost us 2 million, just consider the graft an operating expense, department stores have a realistic idea about this..., catch em when you can,build it in to your price tag and move on....this system is so burdened with rules and laws and system checks and re checks and monitors who monitor the monitors who monitor the monitors who monotor the monitors, that it is laden.... cut the crap....get rid of so many layers of monitors... cut those $$$...move on and provide care to desperate folks who don't care, they just want help to the toilet and to have a meal...and maybe get some kind of enjoyment in their day. Shame on these bureaucrats , dogooders who injure these folks even more and put their paychecks in the back every week...shame on them. The reality is, there are many more people out there needing services than they ever expected. consumers / advocates are getting wise and are not going to take being pushed aside any more, nor should they... these folks are the least able among us and it is our duty as a humane nation to care for our citizens who cannot care for themselves... unless of course the government wants to adopt a policy of euthanizing anyone with a disability... that is scary, lets not put that to a vote...and so you have it, my opinion.

**  COMMENT  **  I think we are hopeless in Florida. This is just too much for consumers and providers to bear. Our legislators really don't care about us, never did, never will.

**  COMMENT  **  without the abilty to sit down with ample time,i will only be able to scratch the surface,but here goes.first h.m.o.,s wont solve your problem,since all dental h .m.o.s, are nothing more than a discount dental plan,in which the patient is still responsible to pay for their services.what needs to happen is get providers to agree on afixed fee schdule,then how much can be budgeted for the patient, treatment plans can spaced out so that a patient who doesnt have the full amount can be stablized and proceed at their own pace. the current system is lacking proper administration , even in the insurane world which is pretty bad the providers still have the ability to discuss treatment optins with their consultants,i cold go no but at present let me continue.i have seen patients with treatment plan auhorized then somehow the patient was sent to another provider,who didnt follow the correct tx, plan only to be brought back to my office only to have me point it out again the patient was removed from my office.i would like to go on however time wont permit. if i can be of further asst,please call me.

**  COMMENT  **  I feel there will be many hard working, dedicated and long-time Support Coordinators and providers leaving the program for better paying jobs with benefits like retirement , no overhead, health insurance, etc. In the long term, the program will suffer as providers with much experience leave the Waiver(s) program in droves.

**  COMMENT  **  How much notice will providers have of what their rate will be?

**  COMMENT  **  Why are they spending extra money on Maximus and Del Marva? The disabled are voters and tax payers. Vote out our legislators and Governor next election. Imagine if one of there children were disabled. Get in touch with Mike Deeson of channel 13 and show him the waste of money with all these organizations watching one another . None of them are worth a dime. Are they taking a 7.21% cut in there pay? I bet not.

**  COMMENT  **  Yes: People with disabilities did not ask to be born with their disabilities .It is up to the goverment to help and assist these people so that they can maximize their idependence . How can they sit in their high class offices and make the decissions they make .May God have mercy on them .

**  COMMENT  **  A good support coordinator is worth their weight in gold (monthly).

**  COMMENT  **  There are APD staff that are too close to certain WSC and other providers and all WSC and providers are not treated equally. Request for assistance is not always equally approved.

**  COMMENT  **  Many of our Legislators have "NO CLUE" about the services that our consumers and their families need. I spoke to one Legislator yesterday and he asked which agency serves our population.

**  COMMENT  **  keep up the good work!

**  COMMENT  **  APD only wants control, thereby eliminating support co-ordinators. The State needs to eliminate hiring additional employees in Daytona. As a provider, we are monitored monthly, Delmarva visits annually, and APD visits annually. To me, the Monitor is enough and monthly is too often....every six months should be ample. With only four Clients, I need to hire a Secretary only to handle paperwork which is rediculous .

**  COMMENT  **  my son has been on the list for 10 years.....

**  COMMENT  **  I think that the TIERS are not going to work. My son is 18 and has multiple medical issues. G-tube feedings, cathed 5 times a day, non verbal, non ambulatory and he just had a stroke this past April as a complications from seizures after reinsertion on a VP shunt. How is $14,000 going to help him and his needs? All you all are doing is forcing parents to put their children in to group homes, because we can 't afford to get them what they need.

**  COMMENT  **  delmarva should be gone.No need for extra costs.those funds could serve so many consumers.Also APD clients should be placed in APD group homes NOT in ALF.Group homes have different training requirements as well staffing patern.It is NOOT fer that we are loosing clients to alf facilities and we could not addmit privat pay or simular.

**  COMMENT  **  the small waiver requires as much work for wsc as the big waiver, 1/2 the pay for the same work.ridiculous. APD has the worst computer management and district 8 management repeats the same duties for one client over and over. pay for wsc should be increased and it will attract more qualified professionals. travel is poorly funded as is dentistry and medical. products are very often over price, a pvc chair for a shower, 400 to 700 dollars, come on? providers of services need pay increases to attract more professional people.

**  COMMENT  **  I was a support coordinator but had to quit with the pay change

**  COMMENT  **  we are washed up but we are not giving up our hope is im JESUS Christ

**  COMMENT  **  we need new Goverment, legislators and State representative in the State of Florida .

**  COMMENT  **  Funding cuts to Providers are forcing us out of business. The State claims to want small "family oriented" group homes but the cut in funds cannot be made up elsewhere and these individuals will end up back in institutions. Our employees get paid less than those who work at McDonald's and we serve developmentally disabled people ; not burgers!

**  COMMENT  **  Families, clients, friends, therapists, teachers,and others all need to go to the polls and replace the legislators who make these uneducated decisions which affect our family members lives negatively.

**  COMMENT  **  I hate to see such needy people that count on us to loose services that are needed .

**  COMMENT  **  I THINK YOU SHOULD STOP TAKING AWAY OUR PROGRAMS AND LEAVE US WITH NOTHING TO LOOK FORWARD TO ONLY TO A BLEAK FUTURE. I HOPE YOU WILL GIVE MORE PROGRAMS TO THE HANDICAPPED PEOPLE WHO FOUGHT TO SURVIVE AND LIVE WITH HELP FROM PROVIDERS AND SUPPORT COORDINATORS.

**  COMMENT  **  There needs to be more advocacy for "Direct Care" Providers. further more, these rate structures for services have been up then down then down again, and many times it's difficult to get paid despite all authorizations showing that payment should be made. Many Direct Care Providers have been, or are going to be put out of business because of this unstable and rather unfair rate structure. The services that were recently cut from Medicaid resulted in harmful affects to the consumers that badly needed and depended on these very services. Between rate changes, services changes , and an abundance of "repetative, and unnecessary" required documentation, it's a wonder there are any "providers willing to maintain thier position". It's amazing to me when a provider doesn't get paid in a timely manner that Medicaid Waiver is allowed to get away with these kind of inconsistencies, because if it were a regular business/employer, the department of labor would be knocking and hefty fines and legal positions would take place immediately.

**  COMMENT  **  I am a respite provider i open my home to families and pay rates have been cut , we work hard and are paid less now for a 24 hour period and paper work for documentation is excessive

**  COMMENT  **  We (all agencies involved in providing quality of life services to the DD population ) need to be realistic and work together in order to ensure safety and well being of individuals living in the community. We need to consentrate on educating the community and helping this population be more seen and accepted din the community .

**  COMMENT  **   NO I DO NOT

**  COMMENT  **  Total Responses: 233

(*Mostly) Unedited

* Last names and other identifiying information removed. Also, some vulgar language removed.

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