The lack of standards in place for emergency intervention raised questions as a new rule for operating therapeutic community residences was brought in front of the Legislative Committee on Administrative Rules on Thursday.
Currently, staff at therapeutic homes are not allowed to physically hold down or reduce the ability of a resident to move his or her arms or to seclude a resident in a room or an area that they are not able to leave. Despite that, disability rights groups want staff working at community homes to learn how to do just that in situations where patients might harm themselves or others.
Rep. Richard J. Marek, D-Newfane, vice chair of the committee, put words on the Catch 22 situation: “You should not do, but if you do — how should you do what you’re not supposed to do?” Marek said.
The committee put the ruling, “Licensing and operating regulations for therapeutic community residences,” (see document below) on hold until its next meeting Aug. 22, and advised the Agency of Human Services to work with Disability Rights Vermont to find a solution.
Therapeutic community residences are transitional facilities that provide individual treatment to residents in need of a “supportive living arrangement to assist them in their efforts to overcome a major life adjustment problem, such as alcoholism, drug abuse, mental illness and delinquency,” according to the proposed rule.
Set up to be a place where patients could reside before making “a leap” back into society, licensing and operating regulations for therapeutic community residences have not been changed since they were created in 1977.
The new proposed rule will affect the more than 30 therapeutic community residences in Vermont, and was put together by the Department of Disabilities, Aging and Independent Living’s Division of Licensing and Protection.
“We don’t believe that an emergency is never going to happen,” said Ed Paquin, director of Disability Rights Vermont. “The state will not be using seclusion or restraint … and we are all for that, but it’s hard to imagine that an emergency is not going to come up.”
As the rule reads now staff are not allowed to intervene, only law enforcement is. DRVT also raised the question what staff working at the facilities are to do while waiting for the police.
“People get killed in two minutes,” Linda Cramer, an advocate for Disability Rights Vermont, said at the meeting.
The organization wants residents to have the same rights they had at the former Vermont State Hospital. In cases where the staff will have to lock someone into a room or hold them until law enforcement takes over, the staff should be trained and there should be standards of debriefing and reports to be written, Paquin said.
“All the rules and paperwork procedures are there for the protection of the clients,” he said.
Disability Rights Vermont is also not convinced that law enforcement is the best organization to handle the type of emergency situation that could come up at TCR’s. Tools that the police use can cause injuries and trauma to the patients, said Cramer.
At a therapeutic home in Williamstown, people employed by the facility had to restrain a resident a couple of years ago. At that time they were not trained, it was a new facility and the person was traumatized and injured and sent back to hospital, said Cramer.
“This individual was on its way to do a leap,” she said. “In an event restrain is used, the staff need to be trained.”
Disability Rights Vermont will try and find a time to sit down with the Agency of Human Services in the next couple of weeks to work out an agreement, Cramer said.
“We will be working with our attorney with the revision that the committee requested,” said Fran Keeler, acting director of DAIL’s Division of Licensing and Protection.
“The goal is to be able to come back with a version that they feel that they can vote on,” Keeler said. “But what exactly will be added to the bill we don’t know yet.”
