The foundations warned that we mustn't falter in this reform effort, according to the Globe, because that would be a sign of “bureaucratic inertia, union resistance, or political malaise.”
It's difficult to question a policy juggernaut consisting of The Mass. Taxpayers Foundation, The Boston Foundation, the Patrick administration, and The Boston Globe. But we'll give it a try.
Our question is: where did these findings in the MTF/BF report come from — particularly the finding that closing the state ICFs will save tens of millions of dollars a year?
Unfortunately, as noted, only an executive summary of the report is available yet on the websites of the MTF and the BF. So, that's all we have to go by right now.
The executive summary (linked above) includes a table with an institutional-vs.-community-bed cost comparison. According to the table, it costs $183,000 per bed in a DDS institution, such as Fernald, compared with a cost ranging from $95,000 to $150,000 per bed in the community system.
What's the source of that information? Beneath the table in the executive summary, it states that the source is the “DMR (now DDS) Community Services Expansion and Facilities Restructuring Plan, Revised March 9, 2009.”
In other words, the source of this cost comparison is the Patrick administration itself. The Mass. Taxpayers and Boston foundations are apparently relying on the administration's cost-savings numbers in reporting to the administration that there are… get this…cost savings.
Very nice arrangement. The administration can then point to this presumably independent report and say, 'We told you so. This report backs up our claim that closing state facilities will save us money. In fact, we look moderate in only seeking to close four out of six facilities. This report says we should close them all.'
Nevermind that groups supporting the developmental centers, such as the Fernald League, COFAR, and others, have been raising questions for years about these supposed cost savings, and pointing out the dangers in closing these critically important institutions. Closing all of the remaining ICFs in Massachusetts would not only not save money, it would have devastating consequences for hundreds of the most vulnerable citizens of the commonwealth and their families.
Those questions and concerns have been conveniently ignored in the MTF/BF report, or rather, executive summary.
BTW, we're eagerly waiting for the full MTF/BF report, and will probably have more to say about it when we get to read it.
I haven’t followed the issue all that closely; can you tell me why it wouldn’t save money? I read the executive summary then looked up DMR’s plan and unless you can refute them the numbers seem to be backed up pretty well.
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p>Also, the report seems to indicate that having these institutions is somehow taking away freedom from affected individuals, citing a SCOTUS decision mandating the least restrictive environment available for treatment. I don’t get the conflict. How does having institutions prevent those who can be treated in the community from doing so? Is that a question of how resources are spent or is institutionalization legally mandated?
You didn’t say anything about the recommendation to close most of HHS’s 149 area offices and consolidate them into 20-24. Does that mean that proposal is unobjectionable?
I would note, however, that it seems inconsistent to me that the report would recommend consolidating lots of small HHS area offices to achieve “economies of scale,” and yet recommend serving residents of former state facilities in thousands of small group homes. What about the economies-of-scale argument in that case?
But my impression is that it’s not the size of the offices per se that matters; it’s the fact that people have to go to up to seven different offices to deal with administrative issues related to the benefits they’re receiving, but would only have to go to one if you combined all of the various EOHHS agencies under one roof.
on why we don’t think the administration’s cost-saving numbers in closing ICFs are correct.
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p>For instance, the administration’s comparison of facility and community costs assume the populations of both systems are comparable in their needs. There is no question, however, but that residents of the ICFs have more profound levels of mental retardation and more severe medical issues on average than community-based residents.
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p>An article in the April 2003 issue of the journal Mental Retardation concluded that cost savings at the macro level “are relatively minor when institutional settings are closed and, if there are any at all, they are likely due to staffing costs when comparing state and private caregivers.”
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p>The administration’s cost-savings figures also fail to include costs of renovating and constructing new facilities for the transferred residents. And they do not take into account the long-stated proposals to reduce the size of the existing facilities and to allow development of the unused portions of the campuses.
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p>I’m not saying a case can’t be made for saving money in closing state facilities. I’m saying the Mass Taxpayers Foundation and the Boston Foundation haven’t made that case. They’re just relying on the administration’s own flawed cost-saving claims.
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p>Regarding the Supreme Court Olmstead decision, it should be noted that the decision advocates institutional care for those who desire it and can benefit from it.
The DMRs numbers for savings have been all over the place. When this started back 2003 the savings started out at $85 million per year and over time that number has been consistently changed and reduced and at one point became “budget neutral”. So its anyone guess how they arrive at $65M…maybe they used a dart board.
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p>As the guardian of a facility resident, I can speak to the least restrictive environment issue.
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p>I don’t dispute that many people are well served in a community based care setting. Good for them–they should have that option available to them. I’m all for community based care if its the right fit for the individual–not because the governor say so or some “think tank” says so. What do they know about it? I wonder if the authors of this report have ever even been to a developmental center and met the resident, the staff and seen the level of care provided before publishing their report.
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p>In fact, Fernald is part of the community-based care system. Thats the secret they don’t want you to know. Thousands use the specialized dental clinic there and hundreds use the therapeutic pool, gym, adaptive technologies centers, church, athletic fields, etc. Since thousand or even hundreds don’t live there, where do they come from? The community. So closing Fernald is just another cut in services to everyone.
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p>For many reasons that I won’t get into here, my family member, and I would venture to say that all people residing in our developmental centers, do not have the ability to live and thrive in a community based care system–period. Don’t you think we would have opted for that years ago if it was possible? Does anyone believe we don’t wish that was possible. The propoganda would have you believe that community based care is something new, some recent ingenious concept, when the reality is it has been available for more than 25 years. No miracles have occurred during that time to change my family members abilities nor are they likely to occur. Moving to the community has never been suggested as the proper living situation by the group of experts I meet with annually (for the past 25+ years) to review the care plan. The developmental center IS the least restrictive environment for his particular abilities.
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p>Unless medical science figures out how to completely eliminate developmental disabilites, sadly there will always be a percentage of people who require the level of care available only in a developmental center. Why should it not be available to them…especially since the facilities already exist, the money has already been spent to build the facility and develop this expertise?
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p>There is a smarter way to do this. It has been proposed and ignored. Reduce the acreage of these large facilites maintaining what is essential and selling the excess land. The residents who need this type of care get to keep it, people in the community get to keep the use of the facility, a reduced facility is more efficient and economical to operate and maintain, employees get to keep their jobs, and the state reaps the windfall from the sale of the land. Sounds like a no brainer to me. How come these two these two “think tanks” didn’t come up with this reasonable solution?
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p>Simple–its not what they were directed to do.
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I heartily agree with ssurette.
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p>My sister-in-law has been in the DDS system for decades. She was a resident of the former Belchertown State School when that facility was a hell-hole, and is now very well-served in a well-run, privately contracted community setting. She is also gainfully employed, and is able to contribute a large share of the expenses for her care. We are very happy with her current situation.
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p>Certainly, the parents and guardians of the current residents of Fernald and the other existing institutional settings would be absolutely thrilled if their loved ones were capable of and could enjoy the same. But they are not.
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p>Why on earth would these parents and guardians be fighting so hard to keep the option of centralized care for their loved ones, if they thought a community setting would be better in their case? That just wouldn’t make sense.
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p>What else doesn’t make sense to me is the apparent complete refusal on the part of the administration to consider what has been referred to as the “postage stamp” proposal to reduce the acreage of the large facilities to allow the state to profit from selling off the remaining property.
One problem with many think-tanks/advocacy/philanthropic organizations like the MTF and BF is that their agendas trump the truth. manipulate the release of their reports.
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p>By giving the executive summary to the press ahead of the public, they are assured that there will be little constructive criticism of their reports. These reports are rarely, if ever peer-reviewed either. The lack of review is cause for sloppiness. A recent example:
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p>Harvard researcher Nonie Lesaux produced a report on third grade reading. In the second sentence of the executive summary, the report makes embarrassingly unprofessional statement:
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p>Lesaux, it should be said, is a big shot in early childhood and early grade research circles. The mistake in this sentence, however, is elementary. The term “grade-level” traditionally refers to grade-equivalent scores. You see these on some tests that say student x is reading at 4.7 or 4th grade 7 month. Grade equivalent scores are normed, the put students on a bell-shaped curve. If 43% of our third graders were reading below grade level, we’d be doing 7% better than the rest of the country. MCAS scores are not normed, they are supposed to reflect student performance on criterion; scores on other tests are supposed to reflect student performance in comparison to other students.
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p>Lesaux should have known better. If she were submitting real research, a reviewer would have picked this up. But the report was not so much an attempt to reveal a truth as it was to advance an agenda. Using MCAS scores as a measure of learning is problematic from a research point of view, but it works in the headlines.
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