You may recall that we reported here that A.T. was transferred out of Fernald in February, apparently against her will, and moved to a newly constructed group home in Bedford. The circumstances surrounding the transfer are currently being investigated by the U.S. Attorney's Office at the behest of U.S. District Court Judge Joseph Tauro. The Patrick administration, which is seeking to close Fernald, has appealed a ruling last year by Tauro that Fernald remain open as an option to current residents unless it can be demonstrated that equal or better care is available elsewhere.
A.T. was one of six Fernald residents who were transferred from Fernald to the group home in February. All six were represented legally by the same corporate guardian, the Arc of Greater Boston (GBARC), which approved the moves in cooperation with DMR.
At the time of A.T.'s transfer, the GBARC CEO made the claim that the level of care at the Bedford home were higher than at Fernald. We were skeptical of the claim, so we filed a Public Records Law request to DMR on March 7 for information about the Bedford group home staffing.
On May 22, more than two months later, we received two lists of names, positions, full-time-equivalent levels, and salaries of DMR staff both on site at the Bedford facility and “available” to the residents there. We compared that data with the most recent staffing information that we have for Fernald from Fiscal Year 2006. Among other things, the data show:
1. Total direct-care staffing (total FTEs listed for “mental retardation workers”) was 48 percent higher per client at Fernald in 2006 than at the Bedford group home today. The ratios are based on a residential population of 8 at the Bedford group home and 181 at Fernald.
2. In addition to nursing staff, Fernald had 67 other clinical and professional staff on site in 2006, including clinical social workers, habilitation coordinators, occupational therapists, physical therapists, psychological assistants, respiratory therapists, speech language pathologists, and a respiratory technician. There are doctors on site at Fernald as well. The Bedford home has no clinical or professional staff listed on site other than nurses, and has no doctors on site.
3. Total nursing staff per client at the Bedford home is 25 percent higher than at Fernald in 2006. However, nearly all the Bedford nursing staff are LPNs. In 2006, Fernald had nearly 2 1/2 times the number of RNs per client than the Bedford facility has on site. RNs are more highly trained than LPNs.
4. The Bedford site has an additional 15 LPNs and 1 RN listed as being “available” to the Bedford facility, but these staff are not located at the site and serve other DMR clients in the area. In addition, DMR lists only 1 occupational therapist, 1 psychological assistant, and 1 audiologist as being “available” to the Bedford facility. Apparently, if guardians want to provide physical and respiratory therapy, speech language therapy, habilitation counseling, and medical services to the Bedford clients, they must seek it outside of DMR. All of those services are available at Fernald.
In another development, the Fernald plaintiffs have submitted a brief to the U.S. Court of Appeals, supporting Judge Tauro's ruling last year. The brief makes a key point about Judge Tauro's decision that many people may not understand. As the brief notes, Judge Tauro never ruled that Fernald must stay open indefinitely, only that it must stay open until DMR is able to place the current residents in equal or better settings and all mandated services are provided at the new locations.
We think the Bedford staffing figures provide evidence—in addition to significant evidence already collected—that equal or better care is not yet available in the community system.
Bedford group home vs. Fernald staffing data chart
(Numbers are FTEs)
1. Direct Care MRWs (mental retardation workers):
At the Bedford site today: At Fernald in 2006
0 MRW IVs 21 MRW IVs making $43,020
0 MRW IIIs 26 MRW IIIs making $37,977
4 MRW IIs making up to $28,852 119 MRW IIs making $34,523
10 MRW Is making up to $32,536 303 MRW Is making $31,588
14 total MRWs 469 total MRWs
2. Nursing Staff
At the Bedford site today: At Fernald in 2006:
0 RN VIs 1 RN VI
0 RN Vs 1 RN V
0 RN IVs 5 RN IVs
0 RN IIIs 10 RN IIIs
1 RN II 41 RN IIs
0 RN Is 1 RN I
0 LPN IIs 15 LPN IIs
4.5 LPN Is 2 LPN 1s
0 Nursing assistants 23 Nursing assistants
5.5 total nurses 99 total nurses
3. Other clinical and professional staff
At the Bedford site today: At Fernald in 2
006:
Clinical social wrkrs. 0 5.5
Education specialists 0 1
Habilitation coord. 0 7.98
Human services coord. 0 10
Music therapist 0 2
Occ. therapist III 0 1
Occ. therapist II 0 3
Physican therapist asst. 0 1
Physical therapist II 0 1
Physical therapist III 0 1
Program coord. I 0 4
Program coord. II 0 2
Psych. asst. II 0 3
Psych. asst. III 0 2
Recreat. svs. sp. 0 2
Recreat. therapist I 0 3
Recreat. therapist II 0 1
Recreat. therapist III 0 5
Respiratory tech. 0 1
Spec. svs. asst. 0 2
Speech therapist asst. 0 1
Speech lang. path. III 0 0.88
Speech lang. path. I 0 1.1
Vocational inst. (A/B) 0 1
Vocational inst. (C) 0 5
0 total other clinical and prof. staff 67 total other clin/prof. staff
;
I think this data speaks to what the deinstitutionalization movement in Massachusetts is all about – it is the deprofessionalization of providing services and care for people of mental retardation, and this deprofessionalization waters down the very real, hard to find services for the people who need them. It allows these community homes to claim they can do it “better and cheaper” when in fact – if they were doing it right – the costs would be exhorbitant.
<
p>The reality here is that Tufts Dental at Fernald provides significant care and services for people with mental retardation whether they live at Fernald or not, and the pool at the Green building is also a Fernald/community resource. Adapt provides computers and assisted technology; there is physical therapy, occupational therapy, respiratory therapy, psychiatric professionals…while it can take months to get an appointment with “community based” providers who may or may not be familiar with people with mental retardation.
<
p>Using facilities like Fernald as an HMO for people with MR, providing these services for community living people and centralized service delivery/residential services for the 3% of the MR population need that level of care, would be the best of all worlds. The Boston Globe supported this model in an editorial in 2003. But guess who is against it? The vendor advocates of the ARC. They just want these facilities closed and that’s that.
Given these numbers, it doesn’t seem possible that A.T. can be receiving equal or better services at her new home in Bedford. If we could get any information on A.T., I would like to know what specialized services she need, how long she has to travel to get to them, how long she has to wait for appointments, how often is the availability of transportation and the availability of staff for these trips a problem. The travel alone must have a negative impact on A.T. I find it hard to believe that a 91 year old women with a heart condition has the stamina to withstand these trips. What about activities that were just enjoyable (such as attending church and day programs)?All of these services and activities that contribute to a good quality of life were readily and conveniently located on the grounds of Fernald. Equal or Better????
<
p>A phrase her GBARC guardian made while in court keeps coming to my mind. “She now has her own closet”. I’m sorry but a new building and a closet just doesn’t come close to meeting the standard of equal or better services.
<
p>I continue to hope A.T. is OK.
David – sometimes you seem like such an intelligent person, but you have obviously been brain washed by the Fernald League. Is your pay check clouding your judgement? How can you look at those staffing numbers and come up with the conclusions you presented? How can you possibly in your right mind compare the staffing pattern of a home in the community to an institution? Talk about apples to oranges!
<
p>When you present the total numbers of direct care staff and clinicians in 2006 at Fernald, do you really think that each one of the 181 residents at Fernald received services from each of those positions?
<
p>And remember, we are talking about a HOME in Bedford. Do you have a Doctor, social worker, respiratory therapists, and speech therapist sitting around your home?
<
p>There are literally thousands of families across Massachusetts with sons, daughter, brothers and sisters with mental retardation requiring the services provided to the 181 people still at Fernald. Do you ever think about them?
<
p>It’s time to get real. The home in Bedford is going to prove what the majority of families in Massachusetts already know: people with MR, even from the institutions, can live and thrive in the community. Is that what this fight is really about? Because let’s face it, as the reality of the fiscal situation of the State become clear, DMR’s budget is going to be affected. And that is when we are all going to hear from the majority; the majority of voters who do not have sons, daughters, brothers or sisters at Fernald. And they are going to want, or should I say demand a piece of the pie.
<
p>Instead of fighting, why doesn’t the Fernald League to what all the rest of us have already done. Right now you are in the driver’s seat. Negotiate now. Nobody knows what the future will bring, but anyone, legislator or state official, charged with the stewardship of the taxpayer’s dollar, is going to do the only logical think. Fernald will close.
<
p>