Skip to content

Are DDS group home staffing regulations adequate?

August 15, 2012

By David Kassel

As we’ve previously noted here, recent allegations of substandard care and other problems in privately run, state-funded group homes have raised our concern about the safety of the state’s community-based system of care.

The Department of Developmental Services, as we’ve also reported, has stepped up long-standing efforts to persuade family members and guardians of Southbury Training School residents to move their loved ones to that community system.

While many group homes in Connecticut are undoubtedly excellent, a series of articles in May and June in The Hartford Courant reported on a number of issues in Hartford-area group homes operated by a provider called Humanidad.  Those issues included employee allegations that staffing shortages were creating a dangerous situation in the homes, that the residences lacked basic resources such as groceries and activity programs, and that the clients in general were receiving subpar treatment.

Since those articles were published, even more troubling allegations of abuse surfaced in July concerning a second Hartford-area group home provider, Options Unlimited.  The Courant reported earlier this month that a caregiver at an Options Unlimited group home, who had been caught on videotape hitting a resident with a belt and dragging her by her hair, told police he felt she had to prove herself to fit in with the staff, “like a gang.”

The woman told police about a mob mentality among the workers at the group home, according to the newspaper, which stated that eight or nine workers at the home had previously been terminated for abuse.

In our view, all of these cases raise questions about the policies of group home providers in Connecticut regarding staffing of their residences.  They also raise the question whether DDS regulations and policies regarding group home staffing are adequate.

An online guide to state inspectors of Intermediate Care Facilities for the developmentally disabled (ICFs) such as STS states that “there is often a relationship between the adequacy of facility staffing and staff treatment of individuals.” 

We examined staffing regulations governing both the DDS group home system in Connecticut and ICFs and found some differences that are concerning.  (Staffing in group homes is governed by state regulations [17a-227-13], while staffing levels at ICFs such as STS are governed by federal Medicaid regulations [42 CFR 483.430].)

In this post, I’ll discuss regulations that pertain to the adequacy of staffing levels in group homes and ICFs.  We are continuing to examine state and federal regulations that are concerned with staff training in group homes and ICFs.

Minimum staffing requirements

The major difference we’ve found between group home and ICF regulations regarding staffing levels is that the ICF regulations appear to be much more specific in requiring minimum levels of staffing and what the staffing levels are intended to accomplish than are the state’s group home regulations.

DDS group home regulations state that direct-care staffing levels in those residences must be “sufficient” to “ensure the residents’ essential requirements for health and safety are met.”  There is no requirement that the homes maintain a minimum level of direct-care staff or licensed medical, clinical, or therapeutic staff.

The only staffing specified in the group home regulations, other than direct-care staffing, is for nursing:  DDS regulations state that the group home provider “shall provide nursing services in accordance with individual needs.”

Interestingly, the DDS staffing regulations for group homes further state that a residence will not be considered to be in violation of the regulations if its staffing levels are “consistent” with the amount of state funding the provider receives.  We interpret this to mean that if a provider of a group home were found to have an inadequate number of staff, it could successfully argue that it was not receiving sufficient funding from the state to hire more staff.  That could conceivably result in a situation in which a group home could remain understaffed with no loss of its license to operate.

On the other hand, federal regulations that apply to ICFs such as STS specify that direct-care staff must be on duty 24 hours a day, and that there be a minimum ratio of 1 direct-care staff to every 3.2 residents with severe and profound levels of disability, 1 to 4 for moderately disabled residents, and 1 to 6.4 for mildly disabled residents.

The federal regulations also state that ICFs such as STS must have sufficient “qualified professional staff to carry out and monitor the various professional interventions in accordance with the stated goals and objectives of every individual program plan.”

This is more specific language than the DDS staffing-level regulations because the federal regulations refer to the individual’s care plan.  This requires a facility such as STS to have a wide range of professional staff available on site.  As noted above, the state group-home regulations say only that staffing levels be sufficient to ensure that “residents’ essential requirements for health and safety are met.”

The federal ICF regulations also specify that each facility must have a “qualified mental retardation professional” to coordinate and monitor each resident’s active treatment program.  That professional must meet specific qualifications, including having at least one year of service in the field.

Hiring and evaluating staff

There are a number of other apparent differences between group home and ICF staffing regulations.  One is that the state group home staffing regulations leave policies regarding such things as hiring of group home staff, performance expectations, duties and responsibilities, and evaluation and termination of staff up to the individual providers. 

Given that there are hundreds of providers in the DDS system, the regulations appear to allow for hundreds of different policies concerning the hiring and evaluation of staff.  This is in contrast to STS where uniform and standardized hiring and evaluation policies apply.

Who can administer medications

An additional difference between ICF and group home staffing requirements concerns the administration of medications.

State law in Connecticut exempts group homes from a requirement that applies to facilities such as STS that only licensed personnel administer medications to residents.  As explained in an online DDS Medical Advisory, state law requires licensed staff to administer medications in residential facilities with 16 or more residents, such as STS.  But the law exempts residences with 15 or fewer residents from that requirement.

“Licensed personnel” is defined as doctors, dentists, nurses, and pharmacists.  Under the law, unlicensed personnel can administer medications in facilities with less than 16 residents after taking  a 21-hour course and passing a test.

For all of the reasons noted above, it’s clear to us that there are two very different systems of regulation for staffing in DDS residential facilities in Connecticut.   The system that applies to group homes is looser with regard to staffing than that which applies to STS. 

Unlike STS, Connecticut group homes have no required minimum staffing levels, and the amount of staff required is not tied to the residents’ care plans.  In addition, each provider in the state is free to develop its own plans for hiring, evaluating, and terminating staff.  And unlicensed personnel are allowed to administer medications in group homes.

The situation at ICF facilities such as STS is very different.  Minimum staffing levels are specified at STS, and the staffing levels must be adequate to meet each resident’s individual plan of care.  Moreover, only licensed personnel such as doctors and registered nurses are authorized to administer medications at STS.

It seems to us that had these more strict staffing standards applied to the group home system in Connecticut, there would be less likely to be situations in which the staff were dominated by a mob mentality that promoted abuse and neglect or that certain homes would be experiencing staffing shortages that resulted in substandard care.

This is one of the reasons that STS guardians are leery of the claim that care and conditions in all or even most community-based group homes are just as good as they are at STS.  It is also a reason that the STS Home & School Association disagrees with a DDS policy of redacting potentially important information about deficiency citations in group home inspection reports.

As we previously reported, inspection reports done on STS are not redacted, other than removing the names of residents; and those STS inspection reports appear to be far more comprehensive than the reports done of group home inspections.

Given that there appear to be relatively loose regulations governing group home staffing, in particular, it is vital that anyone seeking to place a loved one in a community-based residence have access to full and complete information about those residences in order to distinguish the good ones from the bad.

Advertisements

From → Uncategorized

2 Comments
  1. Barry Altman permalink

    What you report doesn’t surprise me. While looking to move a relative to a group home in another state from STS, we consistently found care and services consistently inferior to what our relative was currently receiving. Consequently, he lived out his days at Southbury.

  2. Al Raymond permalink

    Dave,

    As usual, a good, thorough job!

    Al

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

w

Connecting to %s

%d bloggers like this: