In the years I worked for COFAR, I was never able to get the Globe or the media in general to understand that using a per-person cost figure at an institution like Fernald, without making an apples-to-apples comparison with costs elsewhere, is meaningless at best, and highly misleading at worst. Only the Globe’s editorial page has come close to understanding this.
In “The folly of closing Fernald,” the Globe editorial page acknowledged that cost comparisons involving Fernald are difficult to make because of the much more care-intensive population living in institutions than in the community.
But the issue goes beyond even that. As I’ve pointed out on COFAR’s website here and here, Fernald doesn’t exclusively serve the residents living there. Therefore, taking the facility’s entire budget and dividing it by the number of residents to arrive at a figure of $250,000 per resident doesn’t make sense.
Fernald’s budget includes the cost of the dental clinic, for instance, which serves community-based clients. It includes the cost of operating the Shriver Center on the campus, which does research that benefits people with mental retardation throughout the commonwealth. It includes the cost of the adaptive technology building, which benefits people in the community as well. The list goes on and on.
The families seeking to keep Fernald open are not asking to maintain the status quo. They are in favor of developing most of the 190-acre campus, while retaining a portion of the campus as a center for those who need its intensive residential and clinical services. This can be done just as cost-efficiently in the central location that Fernald now provides as would dispersing the residents to privately run group homes around the state, many of which would have to be constructed for that purpose.
like Fernald’s residents “might have a better life somewhere” Nobody doubts that–“might” is the operative word. Look at the failure of Mass to find residential placements for years.
<
p>
I am very familiar with the issues for people with developmental disabilities and their families-although no so much on the specifics of Fernald. New Hampshire did a good job when Laconia closed. They promote individual living arrangements over group homes and have managed to stick to it.
<
p>
Very few people in the field are in favor of institutions. In my opinion the state made a committment to these residents and their families when they housed them in Fernald in the first place. The cost should not be the issue. I think closing the institution should be outcome of finding them community living situations rather than closing the facility and then rushing around trying to place them – possibly far from their friends and family.
I’ve worked for a community provider that serves people with mental retardation since 1991. The homes I oversee are in the neighborhoods around Fernald. One of the houses which was opened in 1985 serves people who used to live in institutions like Fernald. They are non-verbal, have complex medical needs, and need assistance with daily living skills. When the house was first opened the families were nervous and worried if their family members could survive in the community. In 2005 we had a 20th anniversary party. The parents sat around and talked about how glad they were that they had overcome their fears. They talked about the high quality of life their adult children had.
<
p>
That same house has been level funded since 1985. That means the state gives us the same amount of money to care for these folks now as it did in 1985. That is despite the fact that costs have increased in 20 years. In the buisness we call this the underfunded base. In order to survive organizations like mine have to open new houses so we can get todays money for todays client and we can subsidize our old clients with new money.
<
p>
I don’t want to argue with Dave about the actual figure, but I do know it costs at least twice as much to serve a client in Fernald as it does in a house a mile from Fernald. The money spent at Fernald for so few people is money that could be spread over many more people in the community. The staff at Fernald make more than staff in the community and they are not better staff. Many of my staff also work at Fernald. With only a small number of exemptions the clients aren’t any different. Many of the clients I serve lived in Fernald, some of them until very recently.
<
p>
People with mental retardation deserve to live in the community just like the rest of us.
Lynn, I’m pretty sure that if Fernald and the remaining state facilities were closed, the “freed up” money wouldn’t go to your group home. The costs that go into caring for the state facility residents wouldn’t go away. The need for the services that Fernald currently provides to members of your community wouldn’t go away.
<
p>
Where do the residents of your group home go for dental care? Maybe they don’t go to the Tufts dental clinic at Fernald, but many residents in the Waltham area do.
<
p>
Right now, there are hundreds if not thousands of people in the DMR system who are waiting to get into group homes because of a shortage of resources throughout the DMR system. If Fernald and the state facilities are closed, it’s just going to worsen that situation. Hundreds of additional people will now need community placement. New group homes will have to be built for the facility residents. New clinics will have to be opened for them. That’s going to cost a lot of money and that money is not going to go to your group home.
<
p>
The Fernald families are not asking to continue to live in giant brick insitutional buildings. They want to live in small group homes just as your clients do. In fact, many of the Fernald residents already do live in small group homes–on the Fernald campus. This is, and can be done cost efficently. It’s the location and the services that they want to maintain, not the outdated buildings.
Fernald represents an era that is gone. Once upon a time people with mental retardation were thought of as disposable. Parents were told that the kids were better off somewhere else. Somewhere else was an institution. As long as places like Fernald still exist people with mental retardation can still be considered ?other?.
<
p>
The clients I serve live in neighborhoods like I do. They interact with neighbors. The neighbors see that they go off in the mornings. They see them returning from the grocery stores. They see them enjoying cook outs. In some cases they see them enjoying block parties. They are just part of the neighborhood.
<
p>
You keep referencing Tufts dental. A few of my folks go there but the majority go to dentists in the community just like you and I. The lure of Tufts dental is more that they take Medicaid than anything else.
<
p>
If Fernald closed the majority of the clients served could be served in the community at half the cost. The community provider network would certainly advocate for the other half of the money to be spread through the system.
<
p>
You say ?Right now, there are hundreds if not thousands of people in the DMR system who are waiting to get into group homes because of a shortage of resources throughout the DMR system. If Fernald and the state facilities are closed, it’s just going to worsen that situation. Hundreds of additional people will now need community placement. ?
<
p>
There have not been any new admissions to Fernald in years. The current census is less than 200. If Fernald closes it would free up money to help community providers.
individual living arrangements should increase. You dont have any guarantee that closing Fernald will accomplish that. Maybe there have to be line items or other state funding.
Lyn I think that you are absolutely correct that people can be served in the community as less cost and more normalcy. It is the issue of closing the facility when the families have been implicitly assured of security over the years that I think is not a good idea. To uproot residents at this stage of the game because we have deemed their custody too costly stikes me as cold. The vendors that are eyeing the individual service money certainly should be permitted to speak with families and then residents individually, but I dont think that this should be forced on them at this late date. Maybe this is already happening–I dont know how things work at Fernald.
It sounds kind to say close it by attrition, but there are big financial implications.
<
p>
Gary Blumenthal, Executive Director Of AADP (Association of Developmental Disabilities Providers) says
<
p>
<
p>
Families are often afraid of what they don?t know and staff at Fernald have a self interest in painting the community as a scary place. I serve a guy, we will call him John, who lived at Fernald for most of his life, until he was 55 years old. It was only after his mother became incapacitated that he was allowed to leave Fernald. When she was able to say what she wanted she always said he wouldn?t make it out of Fernald- it had been his home his whole life, he was too aggressive, he needed the special services that he could only get at Fernald.
<
p>
John has lived in the community for 5 years. Community living has actually served him well. His medications have been decreased. He no longer feels the need to be aggressive. He doesn’t destroy property. Instead he has a job, belongs to the local library, shops in community stores, goes on vacations with his friends, and so on. He has a life just like yours and mine. He refuses to return to Fernald to go to Tufts Dental. He says he wants to go to the dentist with regular people.
Disclosure: I’m Mrs. LynPB
<
p>
LynPB took me on a tour of Fernald last year. What I saw there was disturbing. Those who advocate to keep it open don’t highlight the fact that many of the buildings are in severe disrepair. Does it really make sense to continue to invest in a severely deteriorated facility that harks back to a time when people with developmental disabilities (and others found inconvenient – recall Michael D’Antonio’s book The State Boys Rebellion) were warehoused away from the rest of society? Community programs can be designed with different levels of services for different degrees of needs. I certainly hope that the state will appeal the misguided court ruling – it makes sense for the court to order services, but not the provision of services in a particular, and in Fernald’s case, crumbling and not cost-effective, facility.
impression about my position re community vs institutional services.
<
p>
Fernald and institutions like it have a sad legacy. People in general are much better off living in the community. Maybe Massachusetts is just too dysfunctionally beaurocratic to take a close the institution by attrition approach.
<
p>
There are competing interests and I dont think any can honestly be considered unbiased. People largely lead more vibrant and normal lives in the community. Residents and their families have a comfort level in the comfort and stability of living at Fernald. Vendors who advocate for closing Fernald immediately have and interest in getting the contracts. Workers at Fernald have an interest in keeping the institution open and they have an interest in sabotaging efforts to change/close it. Residents at institutions are at the mercy of entrenched staff. On the other hand there is something to be said for staff and residents bonding over the years. Residents with community vendors are at the mercy often of transient staff.
<
p>
Are people living in the deteriorated buildings or are they abandoned out-buildings?
<
p>
How does the situation at Fernald compare with Hogan or Wrentham? Are they still open?
<
p>
Can the state mandate that the Fernald staff and family allow community agencies an opportunity to meet with individual families to present your side of the story?
<
p>
I personally don’t like the idea of forced closure against the families’ wishes–especially since I assume many family members are elderly needing to know that their relatives are being securely cared for.
<
p>
That said, I have an open mind about the Fernald issue. Possibly the whole thing is too adversarial for a transitional compromise approach. As a goal I think that closing Fernald is the right thing to do–my apprehension is how it is done.
(a) Who would profit by the closing of Fernald? This has several aspects.
<
p>
What would be done with the property? I presume it would be sold off to developers for various projects. The town would benefit, because the property would go back onto the property tax (!) rolls (property tax, a standing theme of mine). The developers would obviously profit.
<
p>
As an aside, my spouse in the 1980s worked in Cushing Hospital in Framingham for several years before it closed. The infrastructure at Cushing dated from WWII (it was originally a military hospital before it was turned to the state) and the people who were hospitalized there were apparently given excellent care. It was rumored that the closing of Cushing was due in large part because the town wanted the property tax money and developers wanted to knock down the hospital and develop the rather large plot of land on which Cushing sat. I wonder if that’s the same with the Fernald property.
<
p>
(b) Someone upstream made mention of the delapidated nature of the buildings at Fernald. If that’s true, then obviously the state has no particular interest in maintaining its infrastructure. But the “delapidatedness” of the buildings is a separate issue from the care given to the residents. That was one of my points regarding Cushing Hospital above. It’s a shame that the state apparently lets its infrastructure go to wrack and ruin, but that doesn’t mean that the residents there don’t get good care.
<
p>
(c) In Wellesley, there is a group home for the developmentally challenged (I actually like that euphemism). It’s across Oakland Street from Mass Bay Community College, built on state-owned property about a decade ago. There was initially a bit of a NIMBY outcry from the nearby residents, but things seemed to have settled down quite nicely. Something like that is not totally equivalent to re-integration into the community, but it’s a start.
<
p>
Oh, and (d) attrition doesn’t work. The reason should be obvious: the remaining residents would get lonelier and lonelier as people leave. That’s cruel.
I dont think that attrition can be considered to be a cause of lonlinesswhen the numbers of people are close to 200. It is possible that it cannot work because the state is just too beaurocratic.
<
p>
Anyway the two people who wrote the Globe are totally in favor of Fernald Closure without delay. The family members in the Herald are opposed. I am leaning toward opposed to closing it by fiate and I do think that there should be a gradual process. My wife on the other hand thinks that it is impossible to do it gradually and it should just be shut.
<
p>
Anyway — It seems like an obscure issue but I think it is emblematic of how people of good intentions can be in conflct and how policies are hard to fine tune.
<
p>
The 2 Globe LTE”s in favor of closure:
Issues of resources, and hope, in calls to close Fernald
August 21, 2007
IT IS good to see that someone at the Globe understands the realities of the decision by Judge Joseph Tauro to keep the Fernald Developmental Center open. Unlike the Globe editorial (“A reprieve at Fernald,” Aug. 15), which enthusiastically supported Tauro’s decision, Joan Vennochi, in her Aug. 16 column “Looking beyond Fernald,” bases her argument on the facts: that the massive amount of resources that the Department of Mental Retardation must use to continue to support a small number of individuals (less than 1,000) in institutionalized settings results in massive inequities in resources available to serve the other 31,000 individuals served by DMR; that research has shown that people with even the most significant disabilities can live successfully in the community.
<
p>
http://www.boston.co…
<
p>
The Herald LTE in favor of keeping it open:
<
p>
Justice for Fernald
By Sue DeRosa Surette
Tuesday, August 21, 2007
<
p>
Who could possibly question the correctness of Judge Joseph Tauro?s ruling (?Fernald preserved, but at a premium,? Aug. 16)? For decades Fernald has been in the best interest of all the mentally retarded. History shows the treatment of the mentally retarded, when left entirely to the state, was at the very least deplorable. Human warehouses with no care or treatment. Tauro changed that.
http://news.bostonhe…
<
p>