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Committee bill to end all public DDS care must be stopped

February 29, 2012

It’s not just the Southbury Training School that is facing closure in Connecticut if key legislators on the Program Review and Investigations Committee get their way.

A bill introduced by the committee would ultimately close all public care settings for persons with intellectual disabilities in the state and transfer the management to nonprofit providers that contract with the Department of Developmental Services.   If enacted, this bill would lead to higher costs to state taxpayers and poorer care for all DDS clients.

The bill (No. 5036), which was introduced in February, appears to target some 70 state-operated group homes and five public regional centers in addition to STS for eventual closure.

“I don’t think many people realize the extent of this committee’s agenda to privatize care and services in this state,” said Sally Bondy, president of the STS Home & School Association. “This is about a wholesale abdication of government’s responsibility to provide for its most vulnerable citizens.”

Several members of the family-supported Home & School Association testified February 22 at a public hearing against the proposed bill, and told committee members that STS plays a critical role in the care of their loved ones that cannot be duplicated by state-funded providers.  Also testifying against the measure was Bill Meyerson of the New England Health Care Employees Union 1199, who maintained the bill reflects “an ideology that government is never an answer to social issues.”

One provision in the bill would sharply restrict the placement of any DDS client in any state-operated group home.   Under this provision, those public facilities would be made available largely only to residents being transferred from STS.

In testimony to the committee, the Home & School Association maintained that the provision “would reduce choices available to other DDS clients waiting for care and would therefore only worsen the state’s waiting list problem for care and services in the community system.”  This provision was also opposed, for the same reason, by Connecticut Legal Services.

A second provision would sharply restrict the ability of DDS to hire direct-care staff for any public residential or day programs.  This provision appears intended to phase out all public DDS residential facilities and programs through staff attrition.  It would mean that while the public group homes, for example, would be largely made available only to residents being transferred from STS, those same group homes would be systematically starved of their direct-care staffing.  

Thus, guardians, who may have agreed to transfer their loved ones from STS on the condition that the transfers were to public group homes, would soon find that those new residences were being phased out of existence.

While the Program Review Committee bill appears to reflect the DDS’s own stance in favor of privatizing services, it appears to go beyond even the Department’s plans in that regard.  At the February 22 hearing, DDS Commissioner Terrence Macy said his agency would not support the restrictions imposed by the bill on hiring direct-care staff and on placing clients in DDS facilities.

However, none of the committee members present at the hearing used the occasion to substantively discuss or question the potential impacts of the bill.  One lawmaker, Representative Mary Mushinsky of Wallingford, did pose one question to Macy about the possible impact of closing public facilities on the DDS’s waiting list for care in the community-based system.  There are more than 500 persons reportedly waiting for residential DDS care, and some have been on the waiting list for years. 

But when Macy said in response to Mushinsky’s question that moving STS residents to community-based facilities would somehow “incrementally shorten” the waiting list, no lawmaker on the committee questioned it.

No one questioned the commissioner’s claim that there are no plans to close STS either, even though an internal DDS memo projects the virtual shutdown of STS in nine years and a separate memo discusses a six-year closure scenario.

The STS Home & School Association, in contrast to the Program Review Committee lawmakers, has raised many questions about the committee’s bill as well as the methodology of the committee’s reports on DDS services, which claimed that public DDS care is more expensive and of lower quality than  care provided by the nonprofit providers who contract with the state.

In a December 6 letter to the committee, the STS Home & School Association noted that in concluding that care in public settings, such as STS, is more expensive per client than in private settings, the committee failed to compare actual services provided in each setting.  The committee’s cost analysis was based solely on per-client rates provided by DDS for public and private settings. 

Among the services provided at STS for which there was no counterpart in an annual cost report we examined for a selected private group home program were physician and dental services, speech and rehab therapy, case management services, and a range of instructional services.

In January, we wrote to the committee again, challenging the committee’s methodology in concluding that the quality at private Intermediate Care Facilities in Connecticut is “somewhat higher” than the quality of publicly run ICFs, such as STS.   The committee’s report went on to state that this finding supported “a transition to a private residential system for DDS clients,” and further recommended that guardians and families be “educated” about the results of quality inspections in the public and private ICFs in Connecticut.

In our January 3 letter to the committee, we noted that the methodology used in arriving at this quality-of-care conclusion appeared to be flawed.  The report used data on certification inspection deficiencies from a single year (Fiscal Year 2010).  Moreover, the finding was based on a comparison of an average number of deficiencies in facilities that vary greatly in size and the number of clients served.

The final Program Review Committee report found that there were an average of 3.5 deficiencies per public ICF in FY 10 versus 2.9 deficiencies per private ICF.  However, the report also noted that on average, there were about 18 people living in each public ICF residence compared with only 5.5 in each private ICF.  Given that there were on average 3.3 times as many people living in each public ICF compared with each private ICF, it is not surprising that there would be more deficiencies found in the public facilities.

In fact, the number of deficiencies in the public ICFs was only 1.2 times higher than the private ICFs in FY 10.  This appears to be a sign that care quality is actually higher in the public ICFs — the opposite conclusion to what the report reached.

We believe the committee should have compared the average number of deficiencies per resident or per staff rather than the average number of deficiencies per ICF.  In fact, the report noted that there were 680 residents of the public ICFs and 382 residents in the private ICFs in the fiscal year on which the analysis was based.  If all those facilities were inspected, the rate of deficiencies per resident would be only 0.19 per resident at STS and the public ICFs compared with a higher rate of 0.51 deficiencies per resident in the private ICFs.

I would note that while sent our letters to all members of the Program Review Committee listing our concerns about the committee’s methodology, the committee voted unanimously on January 29 to adopt all the findings and recommendations in the report.  There was reportedly no discussion prior to the vote.

Previously, in a written response to  our concern about the quality finding, the committee’s staff stated that reporting deficiencies per resident, as we suggested, would “dilute negative findings” for the larger public facilities. While that is undoubtedly true, it is also the case that reporting deficiencies per ICF unit, as the Program Review analysis did, tends to dilute negative findings for smaller, private facilities.  The committee staff’s written response appeared to us to demonstrate a bias against publicly run facilities that permeated the committee’s report and the bill as well. 

For the record, we are in favor of providing as much information as possible about community placements to STS families and guardians as long as the information is presented in a meaningful and unbiased way. 

Finally, a requirement in the bill of periodic re-evaluations by DDS of STS clients whose guardians have rejected community placements appears intended to give DDS grounds to overrule guardians as primary decision-makers for their wards.  We think this is particularly harmful given the language in the Messier v. STS court settlement, which states that while guardians at STS shall make the “ultimate decision” about residence, DDS can overrule them if it believes they are not acting in the best interest of their wards.

In our view this language in the Messier settlement contravenes the federal Developmental Disabilities Assistance and Bill of Rights Act, which states that individuals with developmental disabilities and their families are the “primary decision-makers” regarding the services and supports they receive, including choosing where the individuals live…” [42 U.S.C. § 15001 (c)(3)]. 

Ironically, it seems that those who do not believe in government’s role as a care-giver to our intellectually disabled citizens, nevertheless appear to support governmental intrusion into what should be the private decisions of the families and guardians of these citizens.  The DDS, according to the opponents of public care and the signatories to the Messier settlement, is somehow in a better position than an intellectually disabled person’s family members or guardians to determine what is in that person’s best interest. 

For that reason, we have proposed a bill in the current legislative session that states that any guardian or family member who selects STS as a long-term placement for their loved one must be presumed to be acting in the best interest of that resident.  Unfortunately, the Public Health Committee leadership has declined to introduce our bill, contending it might conflict with the Program Review Committee’s bill.

We’re left at this point wondering what has happened to the Legislature as a co-equal branch of government with the executive.  And what has gone wrong with the system when decisions and findings about STS and its residents are made without any input from the families and guardians involved?

The chief plaintiffs in the Messier case have lately been joined by DDS and the Legislature’s Program Review Committee in saying: “We know what’s best for you.  Don’t interfere with us!”


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