The costs for serving particular (Fernald) residents in community settings would be based upon a careful assessment of what supports would be needed in order to provide them with equal or better care in the community. Such costs vary according to an individual's particular needs but, in the Department's experience, transitions to community-based programs have historically cost less than providing services in an ICF/MR (a state facility) (our emphasis).
But how does it cost less in the community? Howe doesn't come right out and explain that. But she does go on to state in her letter that the Department's relatively low calcuated cost of $102,000 per resident in the community was based on “the average cost of community-based services” (our emphasis again).
And that's precisely the problem. The population in the facilities and at Fernald, in particular, isn't average for the DMR system. Eighty-six percent of the Fernald population was listed as having severe or profound mental retardation in 2001. That percentage is even higher today. Most residents of the community-based system have mild to moderate levels of mental retardation.
DMR's $102,000 cost estimate for care in the community is based on an average population in the DMR system. Their estimate of $239,000 for care at Fernald is based on the budget of a facility that primarily serves people with severe and profound levels of mental retardation and extensive medical needs.
Leaving aside our contention that the $239,000 is an inflated figure, it stands to reason that clients who have higher clinical and medical needs would need higher levels of staffing for their care, which adds to the cost of that care. If, in fact, equal or better care is to be provided in the community, then the direct-care staffing levels in the community must be the same as, or higher than, those in the facilities for clients with the same level of care needs.
Yet, Howe simply states that equal or better care will be provided in the community for these former facility residents at less cost. As noted, she doesn't come out and say it, but there's only one way to achieve that lower cost, and that is through lower direct-care staffing levels and/or lower pay and benefits. That might work for people with mild or moderate mental retardation, but it won't work for the people at Fernald.
Yet, this appears to be what DMR is counting on when Fernald and the other state facilities are closed: that those former facility residents will be cared for by fewer staff who are lower paid and don't have health care benefits. And somehow the care will be equal or better. That's the disconnect.
This is not a snark, but a genuine question. Everything seems to be coming out of the balance sheet side of the equation, and that’s OK – IF you actually understand who the people involved are. The level of incapacity, as you have said, cannot be gleaned from visiting group homes and assuming that the Fernald population is similar minus, say, 10%.
Much about the Fernald situation concerns me.
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p>Between 1995 and today, the services available to our retarded, our mentally ill, our children-without-families has actually decreased. The size and difficulty of the fights I have had in trying to get residential care for children who were psychotic, who really really needed that level of care have dramatically increased each year [except for some hopeful signs of change towards the end of 2007 with the change of DSS Commissioners]
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p>If you look at it, the number of residential addiction treatment beds was over 1000 in 2002 – and barely 500 in 2004.
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p>The only beds increasing in number are the prison beds, where the “care” is more like 1850 then what was available in 1995 in state facilities. Further, that decrease in state jobs decreased the overall number the number of stable state jobs, which formed one of the entires into the middle class for minorities and struggling families. Our tax and job cuts actually cost this state jobs and income that has NOT been recreated. http://www.cbpp.org/1-12-05sfp…
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p>In the rush to privatization and smaller government that characterized the last decade, Massachusetts cut more state jobs [so I am told – I can look for a good cite] then nearly any other state.
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p>We are one of the three wealthiest states – but rushing back into the dark ages where if someone is ill, not a member of the elite, and limited in any fashion we give them Darwinian treatment and apparently hope they will not propagate. If possible, too, we remove their children, terminate their parental rights, and then celebrate our acts in so doing in National Adoption Day.
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p>I continue to believe that I will be judged one day not on what I own, or have achieved, but hon how I treat “the least of these” and what level of kindness, compassion, and self-discipline I have exhibited.
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p>”Cost” as a mantra excludes kindness, compassion, and the understanding that some folk just plain need residential care and more help to have lives that are safe, let alone dignified.
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p>As a matter of disclosure, I do accept some appointments to do guardian ad litem work at the “state rate” which does not include payment for travel time – and which is paid for by the Scroogian “Commonwealth of Massachusetts” even worse, and more slowly, then for court-assigned representation of the indigent.
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p>The absence of care and concern in governance and in the hearts, souls, of those who would further this process by even eliminating the income tax appalls me.
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p>Merry Christmas Massachusetts.