Gail Grossman, the DMR offical in charge of QUEST, was first asked by one of the callers on the line how often the group homes were visited and licensed.
She answered the question very selectively. Each home that provides 24-hour supports is visited at least six times a year by DMR service coordinators, Grossman said. They fill out standard forms regarding their visits, answering such questions as whether the home appeared clean and whether there was food in the refrigerator.
That's all fine and good. But service coordinators are not the people who license the provider agencies that run the homes. The service coordinator's job is to advocate on behalf of individual residents–not make sure the homes are being run well for all residents.
The actual licensing people may not visit a specific group residence in a given year. As the Legislature's House Post Audit and Oversight Committee pointed out in 1997, QUEST license staff surveyed less than 20 percent of the 1,798 group home sites in the state in 1994. We have no reason to believe the situation has gotten any better since then.
That less than 20 percent of group homes are surveyed each year is disturbing because poor training, low pay and benefits and high turnover of group home staff have been well documented. In 2006, the U.S. Attorney in Massachusetts released a report that expressed concerns about high levels of abuse, neglect, and medication errors in the community system.
During the conference call with Grossman, someone on the line was trying to explain what the service coordinators actually do when they visit the homes. She said that after a long battle with DMR, she finally received one of the site visit forms filled out by a service coordinator. “It was very simplified,” she said. “It said things like, 'I've gone to the house. It seemed like everyone was having a good time.' End of report.”
Another question to Grossman during the conference call: How many times have QUEST licensors recommended that providers not be licensed? Also, how many licenses have been pulled for noncompliance with regulations?
Grossman responded that she would have to get the data to reply to the first question. She said she did not believe that any provider license has ever been pulled during the 15 years the QUEST system has been in place.
Another caller commented that when residents or families have complained to service coordinators about conditions in group homes, DMR has responded not by inspecting the homes or correcting the problems, but by threatening to evict the residents. [This was certainly the case with Lisa Burke, a resident of a group home in Medford, who was run over by a staff-driven van in May 2006 while she sat outside the facility in her wheelchair.
After Lisa Burke's parents and other family members voiced concerns about the accident and about staffing, supervision, and training issues at the group home, a regional DMR director responded by threatening to close Lisa Burke's home.]
I'm not sure Grossman even responded to the comment about DMR's habit of retaliating against those who raise concerns about conditions in group homes. But she did have a response to a caller who said that when group homes do get inspected, the DMR inspectors routinely notify them beforehand. This allows the group home managers to temporarily improve conditions in the homes just before the inspectors get there. Grossman's response was that notifying the group homes before inspections is “just common courtesy.”
When we get responses like that from the DMR official in charge of overseeing group homes in Massachusetts, no wonder we're nervous about that quality of that oversight.
The same House Post-Audit report Dave mentions was so critical of DMR’s investigative capacity that it recommended turning it over to the Disabled Persons Protection Commission. Unfortunately this never happened. Instead the DPPC worked out a series of memoranda with DMR and local prosecutors to share information better, a good step. But the DPPC itself was allowed to languish, and deals each year with more hotline calls and more investigations, yet a shrinking staff. Thus year’s budgets are level, meaning two more staff will have to go, despite a backlog of 800 investigations.
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p>DMR also has dropped capacity. If Gail Grossman must rely on service coordinators as investigators, she must know that service coordinators now have caseloads moving into the high 50s. Every other month is a goal for how often the service coordinators can see each of their clients, and then inspect the group home or homecare situation of each one at the same time.
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p>Again the House budget cuts almost $400,000 deeper into DMR/DDS administration than the governor’s budget, which already cut deep enough to lay off service coordinators. It always seems reasonable to cut administration rather than services, but DMR/DDS — like many other human services agencies — is now primarily a contractor-out. The oversight function is even more important than it was in 1997, when almost twice as many people worked on it (although computers have helped on their paperwork).
I would think the person in charge of QUEST licensing would have a few more facts readily available. It seems to me their reviews are cursory at best. Is the food in the fridge and does it appear clean doesn’t even scratch the surface.
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p>Based on what I have read I am even more frightened by the prospect of my family member or any of the individuals living in ICF/MRs being forced into the community. My fears are well founded. Several years ago my family was driving through Lowell by what we knew was a group home to find an individual walking around on the roof. It was obvious this person was not a roofing contractor. We stopped and fortunately, another passer by had a cell phone and called police and the fire department and this individual was taken off the roof….only to be turned over to the “caregivers” in the house.
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p>I believe the only way to get a true assessment of the quality of care being provided is to just drop in which of course is the ultimate test. Courtesy has no place in assessing the quality of the care being provided to these disabled people.