(Posted on behalf of COFAR)
The Patrick administration’s confident projection that closing four state developmental centers for the intellectually disabled in Massachusetts will save $40 million a year stands in stark contrast to an official state projection of potential cost increases in closing a similar facility in Connecticut.
The Connecticut Department of Developmental Services has declined to make any projection of long-term cost savings in the hypothetical closing of its remaining developmental center, the Southbury Training School. And in a November 2010 “overview,” the Connecticut DDS states flatly that “the closure of STS (Southbury Training School) would not produce any short-term savings.”
Moreover, an earlier 2002 cost study by the Connecticut DDS stated that, “No significant savings will ever result from the closure of Southbury” (my emphasis).
I’ve written here before about our concerns over the validity of the Patrick administration’s savings projections in closing the Fernald, Monson, Templeton, and Glavin developmental centers in Massachusetts as of Fiscal Year 2013. Charlie on the MTA has bemoaned this as a he-said/she-said argument over cost.
Well, let’s look at what the Connecticut DDS has said about the cost of closing Southbury, a large state-run facility of 441 residents that is comparable to the developmental centers in Massachusetts. Certainly, the Connecticut DDS can’t be accused of being an advocacy organization for one side or the other in this debate.
In its 2002 cost study, the Connecticut DDS made the following four points about closing developmental centers, also known as Intermediate Care Facilities or ICFs/MR. Remember, this didn’t come from us:
(A) The majority of people being served at today’s large state operated ICFs/MR have severe and profound mental retardation, in addition to other physical and emotional disabilities.
(B) Moving people from large settings to community-based care will not save money unless the critical support staff are paid and trained less than in the state operated settings (community and facility-based settings). As private operators work to achieve deserved pay equity, savings in this regard will further evaporate.
(C) Transferring residents from a large-state operated setting must be a multi-year effort due to lack of available community-based services. Costs during the multi-year effort will increase — in this case by 200-300%.
(D) Closure stresses an already over-burdened system and will lead to a further rise in the waiting list (in the community-based system of care).
To be fair, the 2010 overview by the Connecticut DDS projects some lower per-diem costs in moving Southbury residents to privately run group homes due, once again, to lower paid staff in the private system. But the overview states, in ruling out the likelihood of short-term savings, that:
There are substantial cost implications [read cost increases] associated with developing an infrastructure to accommodate a parallel service system in the community.
You may recall that one of our criticisms of the Patrick administration’s savings analysis, which it submitted to the Legislature in July, is that it contains no projections of the cost of developing that parallel infrastructure in the community.
We would also note here that we believe savings in operating developmental centers could be obtained, not by closing them, but rather by simply allowing new admissions to them.
Martha Dwyer, who has a brother at Southbury Training School, explains that one of the reasons the per-resident costs at developmental centers in Massachusetts and Connecticut appear high is that fixed costs of operating them have remained as their populations have declined. In both states, admissions to the centers have been effectively blocked for decades. Allowing new admissions to the centers would reduce their per-resident costs all by itself, says Dwyer, who is a Board member of the national VOR, of which COFAR is an affiliate.
In a related matter, we would point out that a recent settlement agreement of litigation brought by the Arc of Connecticut to close the Southbury Training School allows community transition for any Southbury resident who wishes to move, but does not direct the closure of the center.
The Southbury settlement provides another example of Connecticut’s relatively enlightened policies, compared with Massachusetts, regarding the care of profoundly intellectually disabled people.
Kay Schodek, a former licensed social worker at the Fernald Center, contends that unlike the situation in Massachusetts, the Southbury Training School settlement requires that “interdisciplinary teams” involving clinicians be involved in the placements of residents leaving the Southbury facility. Although interdisciplinary teams used to have a central role in the transfer process from Fernald, that role has been placed in the hands of a non-clinical “Transition Planning Team” that has exclusive control over what information is given to clients and families about the options that are available to them, Schodek said.
Only selected members of the clinical team are consulted about proposed placements of Fernald residents. The full team is invited only to the transfer placement meeting, when the placement is “a done deal.” Schodek adds:
This process [of excluding the full clinical team at Fernald from placement decisions] deprives clients and families of the clinical support of familiar staff at what may be the most critical juncture in their lives: a move from the place they have called home for perhaps the past fifty years.
Schodek adds that members of the clinical team, who also used to provide clinical consultation after placement under procedures in place prior to the announced closing of Fernald, no longer do so, and are no longer invited to a 30-day follow-up meeting to develop the resident’s new plan of care, or Individual Service Plan. That follow-up function has also been transferred to the non-clinical Individual Transition Planning team, Schodek said.
The lack of clinical input in the facility closures in Massachusetts has allowed the administration to get people out the door faster, Schodek said. “When clinical teams did placements, the transfer process typically took three months and involved lots of site visits and communication between sending and receiving teams,” she said. “Now it typically takes three weeks.”
But while the transfer process may be happening faster in Massachusetts, we believe it is happening at the potential cost of more inappropriate placements in the community and less successful adjustments to new community residences and programs.
In approving the Southbury settlement last month, U.S. District Court Judge Ellen Bree Burns affirmed that “ultimately it is up to the residents and guardians, as applicable, to make an informed decision if a resident is to move from Southbury…”
Unfortunately, it isn’t working that way in Massachusetts, where guardians and even clinicians are routinely being overruled or ignored as the developmental centers are being closed.