DMR Commissioner Elin Howe- Why is She Against a Feasibility Study?

Feasibility Study for closure of the DMR facilities – Why it matters.

The feasibility study matters because the truth matters.  

The Patrick Administration has done much to help the vendors finally close down the state-run campus facilities for people with developmental disabilities, citing the cost savings in a bleak economy.  The families, friends and advocates of the people who have loved ones in these homes have asked repeatedly for a cost study or a feasibility study of the Patrick Administration, and all they ever received were the flat budget numbers divided by the number of people living in the facilities, despite the fact that facility budgets have long been intertwined with regional and community costs.  Many vendor supporters have suggested that the savings (real or not) don’t matter; this is merely a “policy decision,” which was the very approach Governor Romney tried after his savings turned out to be a pipe dream.  Policy decision or not, it makes sense to have the facts and data in before a decision is made to dismantle a program model that has provided safe, quality,  residential, medical and therapeutic services.  Once these resources are gone – they will be gone for good.  

In reviewing my files on the topic of cost, I came across a study that had been published in the April 2003 American Association on Mental Retardation, called Cost Comparisons of Community and Institutional Residential Settings: Historical Review of Selected Research.   Written by Kevin K. Walsh, Theodore Kastner and Regina Gentlesk Green, the study reviewed the various studies and white papers through the years on cost comparisons between facility and community based care, much of which is cited frequently in this ongoing debate.   What was learned was that the “findings do not support the unqualified position that community settings are less expensive than are the institutions.”  It cited a number of recurring methodological flaws in a number of the studies it reviewed.

So what can be learned from this study?

• There are still more than 250 facilities nationwide with 16 or more beds serving nearly 48,000 people, 80% of whom are classified as having severe or profound developmental disabilities.  (page 103)

• Staffing made a difference in costs; employees at state-run facilities are often better professionalized, unionized and better paid.  (page 105)  The study did not address the rampant turnover witnessed in the vendor-ops.  

• Not all costs are state costs and not all costs are properly recognized in the studies.  ICF-MRs (like Fernald, Wrentham, et al) receive federally-funded support, while not all community based programs are eligible through the HCBW program.  Additionally, some community costs weren’t captured in the studies because they shifted onto other federal or state programs. (page 105)  Examples of this would be shifting costs through federally funded programs for housing (town housing authorities) and food stamps and state funded transportation.  

• Studies need to consider “case mix” when looking at costs; a number of studies failed to include the higher need, medically involved residents in their community costs side, claiming them to be “outliers.”  These so-called outliers make up the very populations served by the large state-run facilities and their costs are REAL, as stated by Walsh, Kastner and Green.  Population differences must be considered.  (page 105)  These types of selected or biased samplings can skew the data.

• Measuring costs has to be controlled and stable.  One study admitted that it obtained community cost data from estimates given by one administrator, and using those estimates for an entire county, while state institution data was obtained by service billings and financial reports. (page 110)  

• Start up and capital costs need to be included in the community cost estimates.  These were routinely excluded from a number of studies, and costs can rise sharply as a result.  (page 122)  

The bottom line is that closing the facilities won’t likely save a dime, and perhaps this is the real reason that the Patrick Administration doesn’t want a feasibility study.    The Patrick study would be subject to a sophisticated scrutiny that it couldn’t meet…it couldn’t wrap the data around a foregone conclusion.  

So if you see Commissioner Howe at the state house tomorrow…please ask her (nicely) to sharpen her pencil and get to work on the study.  The Commonwealth shouldn’t be evicting people from their homes and privatizing just for the sake of privatizing.  The Legislature deserves to have the full picture of the facilities, including the quality and level of care provided and the state costs associated with taking care of very disabled, fragile people instead of the very carefully staged set designed by Patrick Administration appointees to favor the vendors.

One more thing?  If you do see the Commissioner, please also ask her to treat the families of Fernald EXACTLY like she treats the families at service provider homes:

www.vinfen.org/newsroom/documents/voice-11-08.pdf

Guest speaker Elin Howe, Department of Mental Retardation Commissioner, emphasized the

importance of family partnerships between her agency and the public. “Advice from the family is

critical,” she said. “I’ve learned more from the families about the right things to do than from anywhere else. Families know what they need.

Who knew?  This is welcome news, because the families of the people being evicted from Fernald, Wrentham and the other facilities were under the impression that Ms. Howe didn’t give a rat’s patootie about what they think is “right” for their loved ones.  Hopefully, this wonderful sentiment doesn’t only apply to Vinfen families.  

Please share widely!

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