Nonotuck and DDS Licensure, Part III: The People

In previous installments (part 1 and part 2), we discussed the intensive preparation that goes into Massachusetts Department of Developmental Services (DDS) licensure and how Nonotuck staff come together to carry out the process every two years. It’s that holistic approach—encompassing staff across the organization and touching virtually every aspect of the Shared Living experience—that allows Nonotuck to continually refine and improve its services.

These elements are crucial to understanding licensure at Nonotuck. But what about the people most directly impacted by it? How does the licensure process affect the lives of the people Nonotuck supports?

As Vice President of Quality Enhancement, Eastern Services Doug Watts puts it, licensure requirements establish foundational conditions—safe housing, appropriate medication management, financial protections, access to food, protection of rights and other safeguards. Once those are secure, the people Nonotuck supports have a stronger foundation from which to pursue relationships, work, community involvement, valued roles and other things that make their lives meaningful.

“At Nonotuck, everything’s about quality of life. That’s what we want to work with people to achieve—their highest level of quality of life, as dictated by them and supported by us. Everything in licensing is sort of the foundation. It’s that [beginning] level,” Doug says.

From there, he explains, the people Nonotuck supports can pursue the things that make them happy.

“You’re working with people on what they want to do with their lives, where they want to go, what they want to be—their valued roles in the community, being part of a family, who they want to spend time with. You can’t have that without those foundational licensing pieces being in place,” he says.

But the licensure process doesn’t stop at establishing that foundation. It also looks at whether those safeguards are helping create genuine opportunities for people to direct their own lives.

“They really want to see that people have voice and choice in their life—that there is a platform for people to pursue areas of their life that they want to pursue,” says Vice President of Quality Enhancement, Central/West Grayson Fleischner.

Licensure also creates opportunities for Nonotuck teams to take a closer look at the everyday details of a person’s support. As documented in part two of this series, the licensure process involves a thorough examination of records, medication management, financial documentation and home safety.

Program Director Dylan Zukowski of the Auburn office described this process as a chance to reflect not only on what is working, but on what might be improved. In some cases, that closer examination has uncovered issues that might otherwise have been easy to overlook.

“Licensure keeps us honest in our work, which makes the quality of care even better. It holds us accountable, it holds providers accountable, and it [helps] make sure everyone is doing their role in supporting the person,” he says. “If we’re not pointing out our flaws to make things better, then how are we helping that person grow and supporting that person?”

Dylan shares the story of a person supported by the Auburn office whose financial records revealed a recurring $40 monthly expense. After investigating, the team discovered the expense could be covered by insurance, freeing up money for something more meaningful to the person—in this instance, attending a baseball game.

Other discoveries have involved more immediate health and safety concerns. At one home, preparation for licensure revealed that the correct smoke detectors were not in place, while a visit immediately before the audit identified a water-temperature problem following work by the landlord. Both issues were corrected.

Vice President of Residential Services, Eastern Region Jaimie Doucette offers another example of how the licensure process can provide an outside perspective, challenge previous assumptions and lead to better outcomes for the people Nonotuck supports.

A woman Nonotuck supports had moved to the first floor while recovering from surgery for a broken bone. The team initially viewed the arrangement as temporary because they were concerned she would become isolated from the other people in the home, who typically spent time together upstairs. Their goal was to move her upstairs again as soon as her mobility allowed.

During licensure, however, the DDS surveyor challenged that assumption. In practice, the rest of the household had changed its routine. Instead of gathering upstairs, everyone was coming downstairs to spend time with her—and Jaimie says the woman enjoyed the company.

That prompted the team to reconsider whether returning upstairs was actually the best outcome. Staying downstairs reduced the physical demands on her while preserving the social connection they had been worried about losing. Ultimately, she remained where she was most comfortable—not isolated from the household, but very much a part of it and surrounded by others.

“It caused the team to look back and say, ‘Well, this is really a good thing that we’ve set up here.’ It took licensure and the survey to really analyze not just the health and safety risk, but the benefits of maintaining this temporary solution, maybe permanently, because it turned out to be such a great thing,” Jaimie says.

Not every improvement that comes out of licensure is dramatic. Taken together, these examples demonstrate why licensure matters beyond the regulations themselves.

The standards provide the foundation Doug describes, but the process also creates opportunities to ask whether the supports built on that foundation are actually helping people live the lives they choose. Licensure is not simply an examination of whether requirements have been met. It is an opportunity to look closely, listen, reflect and make life better for those we support.

What happens when the DDS licensur process is complete, and what can we learn from it? Check back in for part 4 of our DDS Licensure series.