Is this really such a hard thing to find?
First of all, you may wonder why we asked for this information.
The reason is that on December 12, when JudyAnn Bigby, Secretary of Health and Human Services, announced the decision to close the four facilities, she told The Globe that the closure of these institutions would save the state $80 to $85 million in annual operating costs. In addition, the DMR issued a statement on December 12 that the facility closures would result in “a reduction of current institutional spending by approximately 50 percent.”
The DMR statement was made in a two-page document titled “DMR Community Services Expansion and Facilities Restructuring Plan.”
Savings claims such as these should be backed up by cost analyses, right? Given that we strongly question the administration's argument that closing these institutions will really save money in the long run, we filed a public records request with the Executive Office of Health and Human Services for the analyses. Our public records request was filed on December 22.
As noted, we still have not received any documents or analyses of any kind from EOHHS or DMR. In a follow-up letter on Feb. 13 to the DMR general counsel, I wrote that one would think that cost analyses supporting a major policy decision to close several state institutions would be readily accessible to the administration and would not take months to find and assemble. But so far, they apparently have.
By the way, we last asked EOHHS for their cost analyses supporting the decision to close the Fernald Developmental Center alone, in September 2007, shortly after the administration announced it was appealing Judge Tauro's decision that Fernald remain open. At that time, the administration claimed it was necessary to close Fernald because it allegedly costs $239,000 per resident per year there versus $102,000 per resident in the community system of care.
What we received in response to that original request was an incomplete and inaccurate analysis that was based on:
1. The total budgeted cost at Fernald divided by the number of residents. The analysis didn't take into account the fact that Fernald serves a large number of community-based clients who don't live there.
2. An average cost of care in the community system. In other words, the $102,000 cost of care in the community was based on an average population in the DMR system. This was being compared with the cost of care at Fernald, which primarily serves people with severe and profound levels of mental retardation and extensive medical needs.
The bottom line is that the administration's cost analyses (that we received in 2007 for Fernald alone) show they will have to reduce the level of care in order to save money in closing Fernald–in direct contradiction to their claim that care will be equal or better in the community. We suspect the same will prove true for the other facilities.
because the push to close Fernald isn’t really rooted in the numbers, it is rooted in ideology and greed by the vendors and vendor advocates, which are – for all practical intents and purposes – running the DMR.
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p>After repeated requests, I actually received a budget from Region 6 Director Jeff Keilsen back in 1996; it was illuminating. Intertwined in the costs were the Region 6 offices, community programs and staff, and costs associated with Shriver, the nursing home (which had a completely financial structure re Medicaid) and Tufts. The analysis also failed to recognize the federal reimbursements associated with ICF-MR care, which is 50%. I complained about it and asked to have it amended. It never happened. This is why you won’t get the real numbers to support their “savings.” Even Mitt started at a savings at $4M by closing Fernald….then it was $2 M…..then they called it a “policy decision.” Please. There is very valuable land at Fernald, and the chop-licking has been going on for years.
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p>The “same as or better” benchmark is going to be very difficult to duplicate when an extremely fragile, multiple handicapped individual is moved from a centralized-service delivery setting to a community-based program. And if this clown on Beacon Hill gets away with this wholesale eviction – then these parents and guardians are going to have to be vigilant about holding the vendors feet to the fire, making sure their loved ones are getting service for service matching. That means on-calls docs, psychs, nurses, and no waiting! That means access to the pool, dental, adapative tech, PT, OT…and no waiting, no fooling around. And they better be ready to sue when it doesn’t happen – sue the vendors and the state, because these guys were promised the same as or better level of services for the rest of their lives, courtesy of the 1970’s consent decree.
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p>Asl yourself, folks, why MARC is so insistent on closing these facilities? Because state-run facilities keep money out of the pockets of their sister ARCS who are actually multi-million dollar service providers for the state. That’s right – look em up in the index of providers – they’re all there.
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p>This is less about “let my people go” – and more about following the money.
It’s not about money at all, though that seems to be an argument that people hope will make their case, on one side or the other.
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p>It’s about what’s best for the people with special needs, and how the state can promote the very best care that can be provided for them.
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p>Massachusetts is like a third-world country in this regard. Canada long ago closed all such facilities. Most states in this country have done the same thing. Let’s join the modern age and give these people the care they need and deserve!
Do you really believe that the very best care is available in the community system? This is a system where the caregivers rarely get health benefits and get paid less than they do in the state facility system. There is higher turnover and higher documented abuse and neglect in the community system on a per-capita basis than in the state facility system. Yet, somehow we should all be reassured that the care is better in the community?
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p>Of course this is about money. It’s about dragging everyone down to the same low common denominator of care and services in order to save money. That might work for people with mild or moderate mental retardation, but not people with the severe and profound levels who live in these facilities. The result is there will be no real savings.
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p>The trend you’re talking about is called privatization. Just because it may be happening all over this country and in Canada doesn’t make it beneficial in the long run. There has also been a trend toward deregulation in the past two decades and look where that’s gotten us.
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p>I agree with your last sentence, but I think the families and guardians of the facility residents know something about what that really means.
We should….but that won’t happen, Michael Forbes Wilcox, because it is about the money.
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p>But people do not deserve to die, which is what happens when people who are medically fragile and multiply-handicapped are deinstitutionalized and removed from centralized service delivery models into the very fragmented service delivery model in the community. Dr. David Straus published a paper in the AJMR which showed that these folks die at a 72% higher rate after deinstitutionalization. A follow up study showed that the mortality rate was even higher.
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p>So – is this really the modern age, Michael Forbes Wilcox? This is the reality. Access to medical care for people with MR is very difficult. Moving people away from the services they need to a community where the wait can be months at a time is part of the reason mortality is so high.
http://www.boston.com/news/loc…
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p>My response to you is to “fix” the community model first before you evict these people and shoehorn them into inappropriate service models.
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p>I also want to know why you’re okay with institutional living on college campuses, over 55+ assisted living models, etc? How is it that regular folks get to choose congregate living settings but people with MR don’t?
“Massachusetts is like a third-world country in this regard. Canada long ago closed all such facilities. Most states in this country have done the same thing.”
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p>This is factually wrong. Nine states have closed all such facilities — technically ICFs/MR under Social Security Title XIX. In 41 other states, there are about 120,000 people receiving this level of care. Not all ICFs are large, some are privately operated.
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p>For reasons never stated, Massachusetts does not want to have any ICFs/MR of any size under any auspices. Possibly there is an ideological issue which no one can explain? More likely the overwhlmed bureaucracy of DMR and its only resort — the non-profit providers — do not want to meet the requirements for such treatment. One is staff ratio. One is nursing availability — in many community residences medication is administered by staff with only a few hours of training. One is active treatment. Perhaps the crucial requirement is that CMS inspects ICFs every year. They inspect perhaps 10% of private providers, most of whom have multiple sites. Neither bureaucrats nor private providers like to have federal inspectors.
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p>If Massachusetts would permit smaller ICFs, many famlies and guardians would welcome them. They might be built economically as villages on the sites of the existing developmental centers, preserving some of the values of secure and comprehensive treatment, perhaps even some of the highly experienced and trained staff.
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p>The governor’s extant plan calls for relocating Fernald residents to other ICFs and building new state operated nursing homes. The announced budget is $40-45 million in NEW SPENDING before the savings of $80 million in four years can be realized. In addition, some federal stimulus money may be steered into this area. This is where the cost savings to the taxpayers disappear, and one begins to wonder who benefits from dislocating these fragile residents, merely to cost-shift from one budget to another.
The only large state to close all ICFs is Indiana. Delaware recently built a new one (50 beds), and a few other states have expanded theirs. Although the general trend is to work more effectively with residents to prepare them for life in community residential settings — another reason to keep comprehensive treatment centers with some secure treatment options, by the way — there are also people who fail repeatedly in community settings who can be admitted to ICFs for respite, recovery, or for long-term residence. This is the “continuum of care” argument.
because there are a lot of points there that I don’t think many people are aware of. I wonder if even Gov. Patrick is aware that he is allowing the community-first ideologues in his administration to cut away two thirds of that portion of the continuum of care that is provided by the facilties. If there are people who fail in the community, there will no longer be any room left at the remaining facilities to take them.
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p>As you note, we are heading in Massachusetts toward the elimination of all remaining ICF-level care.
For some folks, a residential setting and level of care is really a life savor. I have worked with suicidal kids for whom a group home or foster home is just not appropriate and cannot meet their needs.
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p>It is not residential setting = bad, community setting = good.
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p>This is an individualized, fact based analysis. No group hoome in the community will EVER have its own heated pool, or sensory-integration equipped Gym.
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p>Being taken to these is time consuming, hard to schedule, and will lead to a reduction in adaptive services and education for some.
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p>Again – there is a percentage of the population that thrives, and requires a specialized setting.
Fernald is to Gabler as Res schools are to Group homes
The Fernald advocates always fail to mention that almost every resident/family/gaurdian at Fernald has been offered placement in a state run group home setting. These homes are staffed by the same highly paid, trained and qualified state workers that currently work at Fernald. The privatization argument is a straw man, a diversion from the facts of this situation. In fact, private vendors don’t want to take residents from Fernald because the their needs are too high. Maybe Weld and Charlie Baker tried to move dd residents to ill-prepared private homes, but that is not the plan here. High need dd residents have been cared for in a network of state run group homes for 20 years. The very same type of residents at Fernald are in these state run programs.
Big effing deal. The Governor’s people are promising placement in group homes with highly qualified, Fernald staff today….but there are no guarantees after a year. And after the layoff so that they can water down services…and the vendors take over….what’s left? Besides, you’re missing the whole point about the service delivery model. Will Fernald residents have the same access to doctors, psychs, nursing, physical therapy, respiratory therapy, dental, pool and adaptive technology? Of course not. The cookie cutter, one-sized fits all is a bad model that a fellow Democrat is leading the charge on. It’s disgraceful.
Humanservicers is entirely right that every resident/family/guardian at Fernald has been offered placement in a state-run group home setting. The terms of the 1983 federal court settlement require equal or better treatment, and few private providers are equipped to equal the medical services required under federal ICF/MR certification.
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p>This raises two issues, however. One is that the more professional intentions of the present DMR leadership have lead to a tacit acknowledgement of the true costs of supporting this fragile, aging population. DMR/DDS has admitted that it will take $45 million in NEW STATE SPENDING to relocate people from developmental centers, before they can realize the $80 million in savings FOUR YEARS FROM NOW. Once the state legislature looks at these numbers, I hope it will delay the closures during the present financial crisis. With DMR residential already backed up, and no real financial plan in place, they should not be closing anything at this point — certainly not something that is more efficient than the unbuilt replacement and that residents and their families like. People still at Fernald have been offered transfers, coerced and baited into transferring, and have turned these offers down many times. ArcGB as corporate guardian kept wards at Fernald for 10-15 years while ArcMASS was publicly demanding that it be closed. Only a year ago did their judgement change and then they transfered all their wards.
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p>The second issue is what actually is “institutional” and “community” when you get down to individual situations?
A guardian at Templeton put this to Commissioner Howe in a meeting last month: “My brother would be more insitutionalized in a group home than he is at Templeton. Here he can decide where to go each day in a neighborhood of people like himself. In a group home, he couldn’t cross the street without someone with him (which he hates), because he doesn’t look, and he can’t be understood unless you know him really well. He would be parked in front of a TV set.” Now this isn’t everyone, but for this person, the least restrictive setting is clearly an “institution.”
Get your pitch straight. You state that people like Fernald residents have been cared for in state run homes for 20 years and in the same breath you tell us that these homes don’t want Fernald residents because their needs are to great. That makes those of us faced with the closing feel so much better. So–not only are we expected to accept placing our family members in these homes we don’t want but where our family members are not wanted.
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p>Reading between your lines, the homes don’t want them BECAUSE THEY CAN’T PROVIDE THE SERVICES REQUIRED which is the very point.
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p>WAKE UP. This administration couldn’t care less about these people. They can’t wait to evict these fragile people regardless of the consequences. Federal stimulus money (about $5+ million) is slated for destruction of Fernald buildings. Evicting these fragile people is more important then fixing the roads in the state (I imagine the roads in Iraq look like our roads). Or fixing the bridges that you have to say a prayer before using.
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p>I read in a Boston paper two days ago that he wants to spend 21+ million of stimulus money on solar-powered trash bins. $21+ million on TRASH BINS while he is slashing human service budget and closing facilities for the mentally retarded!!!
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p>EVIDENTLY TRASH IS MORE IMPORTANT TO THE GOVERNOR THAN HUMAN BEINGS.
Let’s take the state agency out of this completely .. just for a moment. Imagine – within seconds your life changes and you loose your control to speak, move … or your brain functions differently where you can still speak or physically move, but it is limited and others have difficulty understanding you and you need physical assistance to complete daily tasks. Bottom line, your thoughts are trapped and for whatever reason, you are not able to communicate them clearly. You now have no control on whatever it is that pertains to your life. Even though you cannot speak them clearly with words, your desires and wants are ignored and decisions are made by others about where you will live, what you eat, what activities you participate in and the people you will associate with. People assume you don’t understand and you are no longer treated the same —
Think about where you would want to live. As a parent of a child with disabilities, there is no way I would want him to live in an institution. Although he does not speak with words, he has lots to say and has no problem saying it — his eyes, his smile, his frown, his physical movements — they speak loud and clear. Those who cannot “hear” him are not listening because their expectations of him are low – presumed incompetent.
Those who can hear him WANT to hear him. They see his abilities, recognize and appreciate the gifts he gives to others and respect him for who he is as a person. Are is disabilities ignored? No, why would they be … they are what make him the awesome & beautiful person he is today. I’m blessed, proud & happy to say that his younger brother and sister are just as awesome & beautiful as he…they are more the same than different.
Do we have a true understanding of the meaning of words such as facility (quality of being easily performed, something built for a purpose), residence (a building where one resides), retarded (an offensive word to describe slow – limited), institution (an act of founding, an established practice or custom, an asylum) … Close the institutions– To coalitions advocating for the institutions to remain open..use your funding to do what your mission says “advocate for quality care”.. it appears the mission is to keep institutions open — huge difference.
Families and their supporters are gathering on Beacon Hill this Wednesday asking legislators to restore cuts the governor’s FY ’10 budget calls to eliminate Family Support and other disability services provided by DMR (Development Disability Services DDS). Many individuals with disabilities and their families have a vision for their family that does not include residential placement. Home & Community is where the Heart is…
Thank you MFOFC, The Arc of Mass, ADDP, M.A.S.S., MDSC, AFAM and many other organizations advocating for individual and family support.
is EXACTLY what we’re doing. The centalized service delivery model found at Fernald…found at private facilities….found at college campuses and over 50+ living centers…is exactly what our loved ones need. When a loved one needs 24 hour nuring care – do you have them reside at a facility that supports 24 hour nursing or do you house them in a house without nursing? That’s the ICF-MR model; access to the care that people with MR need.
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p>So let me tell you about my awesome family. My sister was born with profound MR and cerebral palsy; she never walked or talked. She weighed 65 lbs on a good day, had a trach, g-tube, and was oxygen dependent. My mother died having her. My grandparents moved in with us to help with her physical therapy that went on for 12 hours a day; we had a group of volunteers come in, every hour on the hour, from 7 AM – 7 PM. When my father remarried, his new wife joined the team and worked her rear-end off.
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p>When my sister got to be about seven years old, her medical needs overwhelmed my family. She needed far more than we could give her, and she was moved to Fernald. She was brought home every Thursday night, and stayed until Sunday night.
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p>And this tiny, very medically fragile little woman lived to be nearly 39 years old. The doctors at the time said she’d never live to be 12. I think that says something about the love and care she received. Her caregivers were like family to us.
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p>Is Fernald a community? Yes it is, just like yours. On the grounds is a church, where the residents, staff, and the public gather to worship every Sunday. There are fairs and parties, holiday dinners. The residents have family and friends who love them – just like your family. The only thing different is the medical model, which provides 24 hr nursing, and PT, OT, RT, dental, and adaptive technologies on the grounds. There’s a lot of love there, and as hard as the vendor advocates like yourself – try to make Fernald sound like a prison or a warehouse, nothing could be further from the truth. Fernald sustains a medical model that the residents need…just like any congregate living setting.
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p>So please, don’t hate or judge these families for wanting the right set of services for their loved ones. They’re no different than you are.
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p>BTW, welcome to BMG; I see this is your first day here. Tell Leo I said “hi.”
To Mama Di:
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p>First: I resent your comments. What makes you think that we who have family members residing at Fernald do not treasure them. Because we believe that Fernald is the best environment for them we do not feel they are beautiful & awesome or are blessed to have them as part of our family. Plain and simple–we are fighting for our family members lives–we want to have them in our lives as long as we can. Would you do anything less? Do you really believe we are fighting to keep our family members in a terrible place?
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p>Second: Before you judge us, check your history. The family members we are fighting for are the ones that paved the way 30+ years ago so that you would have a choice in the care of your disabled child. Don’t be so quick to forsake those that fought for what you now enjoy.
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p>The holier-than-thou MFOFC, ARC, ADDP, etc, etc, etc. exist because of these people and the actions of their guardians for institutional reform. Isn’t it ironic–they have turned out to be one of their greatest adversaries. No longer do they advocate for what is best for ALL the mentally retarded (theres that pesky word) only for those that agree with philosophy.
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p>Your user name says it all.
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