(Cross-posted from the COFAR blog)
The Patrick administration claims that the average per-person cost of Department of Developmental Services vendor-run group homes is less than the average per-person cost of state developmental centers for persons with intellectual disabilities.
But we’ve now identified some specific missing group home costs that we think the administration overlooked in its analysis.
An apparently typical DDS vendor contract, which we have reviewed, did not specify any psychological or therapeutic services, and only specified minimal nursing services. Developmental center budgets, on the other hand, do provide for all of those services.
This appears to be the first major confirmation we’ve been able to obtain, after months of Public Records Law requests from DDS, that the Patrick administration’s savings claims in closing four developmental centers in Massachusetts are based on an apples-to-oranges comparison. The administration has not fully responded to our follow-up questions about these costs.
I asked DDS Commissioner Elin Howe on June 16, after we had first reviewed the $1.2 million contract, whether medical, clincal, and therapeutic services were available to the residents of the program, and, if so, how those services were funded.
The email I received in response from DDS General Counsel Marianne Meacham, dated July 2, stated the following:
With regard to your questions regarding clinical services available to individuals in the particular…program site, as you know, a full array of clinical services (medical, physical therapy, speech therapy, occupational therapy, psychological, etc.) are available to the individuals in the program through community providers as needed and set forth in the individual’s individual support plan.
This carefully worded answer states only that medical, clinical, and therapeutic services “are available to individuals in the program,” but it doesn’t say how those services are funded — in other words, where the money comes from. Here’s why that is a key question:
In July 2010, the adminstration provided a cost analysis to the Legislature, which claimed a $20 million annual savings in closing the Templeton, Monson, and Glavin Developmental Centers and transferring most of their residents to vendor and state-operated group homes. In the cost analysis, the administration specified a “community residential” cost per client of $107,689. After adding an average “day services” (work and daily living skills programs) rate to that cost and an average transportation rate, the administration computed a total “community services cost” of $140,955 per client.
The administration then compared that $140,955 total community cost to an average per-person cost at the Templeton, Monson, and Glavin centers of $233,902. The administration’s conclusion was that serving a client in the community was $92,947 less expensive than in a developmental center.
After we asked DDS, starting last December, for all documents supporting its community residential cost figure, DDS provided, among other things, a spreadsheet listing total costs of close to 1,000 vendor contracts in FY 2009. We selected one of those contracts for closer review and asked DDS for a copy of it.
The Fiscal Year 2009 vendor contract with the May Institute, Inc. specified 24-hour staffing in a program serving 14 individuals. The contract further stipulated a rate per client of $286 per day, or $104,400 per year. This was quite close to the $107,689 community residential rate in the administration’s analysis.
However, as noted, the $104,400 community residential cost did not include clinical, therapeutic, or full medical costs of care available to community-based residents. The budgets of the Templeton, Monson, and Glavin centers do provide for those services.
On July 6, I emailed back to Meacham at DDS, asking once again how the medical, physical therapy, speech therapy, occupational therapy, psychological, etc. services available to residents of the May Institute program were funded for the residents of the May Institute program. To date, I’ve received no reply to my question.
This is why we need an independent study of the cost of closing the Templeton, Monson, and Glavin Centers.
It shouldn’t be so difficult to obtain a straightforward apples=apples and oranges=oranges cost comparison, a simple algebraic equation. A + B does not equal A + B minus C. Any attempt to make this comparison less transparent has its reasons.
and the services it does and doesn’t specify, please see our July newsletter’s lead story, “Gap seen in DDS funding for community services,” at http://www.cofar.org/PDF/VOICE_July%202011.pdf.
at this point that you have caught Elin Howe in a big fat lie. When you write to an administration official and receive what is really a non-response from a lawyer instead because Elin doesn’t want to communicate directly with you for fear of tripping herself up…
When it takes weeks for this department to respond and still not answer the question that has been asked…
It would appear that in the scattered settings of group homes, the costs for the more limited clinical services have been shifted to individual Medicaid, and that’s why these costs do not appear in the vendor budget. It’s important to note though, that the two types of services are not the same.
A group home resident needs to find a provider who has the patience and experience to work with the severely disabled, needs to find round-trip transportation to an appointment, needs someone who can be a driver to the appointment, and then, even if more appointments are needed, will find that the benefit has been capped and is no longer available. None of this would apply in the ICF community.
I wonder…if you were to extract the costs of clinical services from the ICF budget, as is the case for the vendor homes, if that would result in a lower per-person service cost for the ICF.