As we suspected would be the case, the documents indicate that many important costs of community-based care were left out of the administration’s analysis. And, as we’ll explain below, at least part of the analysis is based on an inappropriate apples-to-oranges comparison of developmental center and community-based residents.
First, I’d note that the administration appears to have submitted two entirely separate analyses in the same report to the Legislature on the cost of closing the centers. The first analysis primarily used DDS budget costs and came up with a $14.7 million annual savings in closing the centers; and the second analysis used what were described as “fully loaded costs,” meaning they included some additional fringe benefit and other costs that DDS factored in. That analysis came up with a $20.3 million annual savings in closing the centers.
The records I received on Friday indicate that the administration’s first analysis was based largely on what the records stated is a $150,000-per-person, yearly cost of operating a group home for eight former residents of the Fernald Developmental Center. (This appears to be a group home in Bedford, although the DDS letter I received on Friday doesn’t identify it as such.) The analysis multiplied the $150,000 cost of the group home by 97 Monson, Templeton, and Glavin residents projected to be transferred to new community-based residences, and came up with a total cost of care in new community-based residences of $14.5 million.
(We had specifically asked DDS for documents supporting that $150,000 cost. The only thing DDS provided us was a one-page budget sheet, which the DDS letter stated was a budget for the group home for Fiscal Years 2008 through 2011. It’s unclear from this budget sheet, though, how the $150,000 cost was calculated. We will probably have to file another Public Records request with DDS and we may continue our appeal with the state Public Records Division.)
As part of the same analysis, the administration also determined that it would cost $95,000 per resident to place a projected 76 former Monson and Templeton residents in existing community-based homes (total $7.2 million), and $135,000 per person to place 42 Glavin residents in existing community-based homes ($5.7 million). The administration also determined that it would cost $70,000 per resident to place a projected 59 residents at the Wrentham Center ($4.1 million). The total cost of closing the three developmental centers was therefore determined to be $31.6 million.
(Despite our request, the DDS provided no backup documents showing how those figures for placing Monson, Templeton, and Glavin residents in existing homes or in the Wrentham center were derived. Why was the Wrentham center cost only $70,000 per resident, for instance, if developmental centers are supposed to be so expensive?)
The analysis then used the Fiscal Year 2009 bugets of the Templeton, Monson, and Glavin centers to determine costs per person in each, and multiplied those figures by the number of residents projected to be transferred from each facility to determine a cost of keeping the three centers open ($46.3 million).
The analysis concluded that closing the developmental centers will therefore result in an annual savings of $14.7 million.
Unlike the first analysis, the second analysis appeared to be based on the average cost of care in the community-based system as a whole. The administratation appears to have first calculated a fully loaded community residential cost in Massachusetts in FY 2009, which was listed as $603.2 million for vendor-operated homes and $163.8 million for state-operated homes. It’s not clear where those numbers came from, but they appear to track line items in the FY 2009 state budget for community residential and state-operated group homes. The numbers are a little higher than the budgetary line items possibly because they are fully loaded figures.
This cost analysis then added $19.2 million for day services and $16 million for transportation services to the other two amounts for vendor and state-operated residential care to derive a total community-based cost of care that could be compared with the cost of operating the Templeton, Glavin, and Monson centers. (Again, it’s unclear where the day services figure came from, in particular, because the Day Program line item in the budget in FY 2009 was around $128 million.)
The DDS documents show that the administration then calculated yearly, per-person costs for residential care, day services, and transportation in the community system, which were then added together. That sum was multiplied by the 215 residents projected by DDS to be transferred from Templeton, Monson, and Glavin to both new and existing homes in the community system. The total annual cost of community-based care for those residents was projected to be $30.3 million.
Next, the administration calculated a fully loaded cost of transferring a projected 59 residents from Templeton, Glavin, and Monson to the Wrentham Center, and came up with a figure for that of $13.9 million. So the grand total of placing 274 Templeton, Glavin, and Monson residents in both the community system and Wrentham came to $44.3 million per year.
Finally, the administration used the Glavin, Templeton, and Monson budgets for FY 2009 to calculate a total, fully loaded cost of serving the same 274 residents, and came up with a figure of $64.6 million. The administration concluded that there would therefore be a savings of $20.3 million in closing the developmental centers.
Here are some of the questions we have about both analyses:
First analysis: The budget sheet for the group home for former Fernald residents lists certain staffing and other costs for the group home in Fiscal Years 2008 through 2011, but it doesn’t break those staffing costs down in any way. As a result, it’s impossible to judge whether the costs listed for the group home are comparable to the developmental center costs cited by the administration.
For instance, does the $818,224 listed as employee compensation in the group home budget in FY 2009 include staffing for day programs outside the home? Does it include the cost of transportation and medical care for the residents? Does it include day habilitation costs, and service coordination costs? We don’t think it does; yet, all of those costs are included in one way or another the budgets of the developmental centers.
It was also unclear how the numbers on the budget sheet relate to the claimed $150,000 cost of operating the group home. And does that $150,000 include housing subsidies and food stamp costs, which help pay for housing and meals in the community system? Again, we don’t think those costs are included.
Also, we would question the validity of basing an analysis of the cost of care in new community-based homes on the cost of care of just one group home. Among other questions, are the particular Fernald residents in the Bedford home representative of all residents in the facilities slated for closure?
Second analysis: How were the figures for community residential, state-operated residential, day, and transportation costs derived in the fully loaded cost methodology?
Do the Bedford group home costs factor in any way into this fully loaded cost analysis?
Also, is the methodology of this analysis based– as it appears to be– on a comparison of the average cost of care in the community with the average cost in the three developmental centers? If so, this is the apples-to-oranges comparison we’ve been talking about all along. The developmental centers serve older, more medically involved, and more intellectually disabled persons tha
n does the community system on average. As a result, transferring those people from the developmental centers to the community will not necessarily result in a savings.
As is the case with the first analysis, do the community-based costs in the fully loaded cost analysis include medical care, day habilitation, service coordination, housing subsidy, and food stamp costs? We don’t think those costs are accounted for here either.
In both analyses, is the relatively small number of people projected to be transferred to Wrentham realistic? Using the administration’s figures, if more people were transferred to Wrentham, the projected savings in closing the Templeton, Monson, and Glavin centers would drop.
Finally, do either of these analyses include the cost of further renovations at Wrentham that would have to be done to accomodate the additional residents projected to be sent there? We don’t think they do.
The bottom line is that in our view, numerous questions surround the administration’s claimed savings in closing the Templeton, Monson, Glavin AND Fernald developmental centers (Fernald wasn’t even included in the cost analyses submitted to the Legislature). We therefore have a couple of questions for the members and staff of the House and Senate Ways and Means Committees and the Children, Families, and Disabled Persons Committee, which received the administration’s cost analyses last summer:
Has anyone on these committees actually reviewed these analyses, and, if so, do they have any of the same questions we do? Last fall, we wrote to the three committees, raising some preliminary concerns about the cost analyses. We’ve still not heard back from them.
if you can upload your request and the documents you’ve received so far in this post, I’ll front-page it.
and I don’t have a scanner. If you have a scanner, I can fax them to you.
Dave has done an outstanding job of examining the figures contained in the DDS spreadsheets, and trying to track how the Department arrives at its purported cost-saving conclusions.
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p>If I understand correctly-that the DDS analysis interpolated the Bedford group home figures to conclude that exactly the same savings would accrue from any eight individuals in any group home-why did DDS select this particular home as the basis for their overall number crunching? I’m certain it wasn’t selected at random. Dave’s question is crucial– are the particular Fernald residents in the Bedford home representative of all residents in the facilities slated for closure?
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p>Are we to assume that other residents in other homes require the same level of care? Or is this cherry-picking data? We all know that statistics can be manipulated and massaged to support nearly any agenda, and that seems a clear possibility here. I can’t help feeling we’re witnessing a shell game.
whether the particular residents of this group home are representative of all developmental center residents, there’s also the question whether the services provided by this particular group home are fully adequate. Maybe this particular home provides services at a cost of $150,000 per resident because it isn’t fully meeting the plans of care of these residents. Or maybe it’s barely meeting the plans of care, but is providing less than the average levels of care and staffing of other, similar community-based homes. We don’t know the answers to those questions.
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p>I’d just note as well that when I asked for “any and all analyses and/or backup documents” that were used in developing the $150,000 estimate for placing developmental-center residents in new community homes, the only thing I recieved from DDS was the one-page budget document for this particular group home, as noted in my post. Is DDS saying that this single page is the extent of the support documents it used in develping its projected cost of care in new community-based homes in Massachusetts?
Our state government desires to build a $302 million addition to Worcester State Hospital. They’re trying to eliminate these facilities.
Next new state prison location?
Dave – the projected cost per resident seems to assume that the person is able-bodied, and able to perform simple tasks for themselves. This isn’t true for many of the projected transferees. The seemingly inadequate estimates for medical costs is what makes this look unsustainable.
that was calculated by the administration using its fully loaded cost methodology is based on the average resident in the community. As you note, that person is not the average developmental center resident, who is likely to have a more severe or profound intellectual disability and more serious medical issues. As far as medical costs go, it doesn’t appear as though the administration is even taking them into account in its community-based cost estimates. That’s because doctors in the community system are paid out of the Mass Health budget and not the DDS budget. Doctors in the developmental centers, however, are paid under the DDS budget.