DDS expands privatized services despite family preference for state care
Patricia Murphy had to file a federal lawsuit in order to get her intellectually disabled sister out of a corporate, provider-operated group home, where she says she was subjected to abuse and inadequate care, and into a state-operated group home.
Murphy’s case illustrates how difficult the Department of Developmental Services has made it for people either waiting for services or receiving inadequate services in privatized group homes to obtain state-run residential placements in Massachusetts. DDS funds group homes run by both corporate providers and by DDS staff.
At the same time, people living in state-run developmental centers have been given priority in finding state-operated group home placements when the developmental centers have been closed.
Here are some facts to consider:
- More than 87 percent of the 372 people who have been transferred since 2008 from four developmental centers marked by the administration for closure have gone either to state-operated group homes or to two remaining developmental centers (primarily to the Wrentham Developmental Center). Only 47 people — less than 13 percent of the total — were transferred to corporate, provider-run group homes. This, to us, indicates, a strong preference among families and guardians for state-run care.
- As a result of this apparent preference, DDS has built 49 new state-operated group homes since 2008. But it has closed 28 such residences during that same period, resulting in a net increase in state-operated residences of only 21.
- There are apparently vacancies in state-operated group homes. DDS figures show that nearly all of the 99 residents living in the 28 residences that have been closed were moved to other state-operated residences.
- Yet, DDS is placing a priority on boosting funding and resources not to state-operated care, but to corporate providers, and has either cut funding for state-run care or provided more modest increases for it. The governor’s proposed Fiscal Year 2015 budget would result in an increase in the provider residential line item of almost 17 percent in inflation-adjusted terms, more than double his proposed 6.5 percent increase in the state-operated residential line item.
The new state-operated group homes built since 2008 appear to have been intended to accommodate only the residents transferred from the developmental centers. They have apparently not been made available for virtually anyone else. DDS is not only not building new state-operated facilities for persons other than former developmental center residents, it is apparently not letting people other than developmental center residents even know about the existence of state-operated residential care options.
Thousands of disabled individuals are reportedly waiting for residential services in Massachusetts, although the state does not maintain an official waiting list that would publicly identify the number of people of waiting. Others, such as Patricia Murphy, are apparently trying unsuccessfully to move family members or wards in the DDS system from provider-operated to state-operated care.
The administration’s policies of under-funding state-operated care, closing existing state-operated group homes, and preventing people from choosing state-operated care as a residential option are combining to reduce the availability of high-quality care throughout the DDS system. Direct-care workers in state-operated group homes have better training and benefits than workers in the provider-operated system. That’s why families from the closing developmental centers have chosen state-run facilities for their loved ones. But the administration appears to be more interested in promoting a privatized, provider-run system than in placing people in settings offering the best care.
According to information from DDS, 157 new provider-run homes have been built since 2008, bringing the number of such homes to more than 1,800 in Massachusetts. In contrast there are just 261 state-operated group homes in the commonwealth and only two fully functioning developmental centers that are not currently targeted for closure.
DDS has stated that it is currently projecting to build five new state-operated group homes, but it is also projecting to close six of them. Our question is why. Why build new state-operated homes and at the same time close existing homes, and moreover, why close these homes while people are waiting for residential placements?
Patricia Murphy’s lawsuit, which was filed last year, alleges that DDS routinely fails to disclose the existence of state-run homes and developmental centers to individuals applying for DDS care, and portrays corporate, provider-run homes as the only option for them. The plaintiff in the case, Kathleen Murphy, is severely intellectually disabled, and was a resident of a group home operated by a corporate provider to DDS. (Disclosure: Kathleen Murphy is represented by Thomas Frain, an attorney who is president of COFAR’s Board of Directors.)
“We had been asking DDS since 2006 to get her (Kathleen) into a state-operated group home, and they wouldn’t do it,” Patricia Murphy says. The federal complaint maintains that Kathleen Murphy suffered severe psychological harm and a risk of death in provider-run group homes. She was finally moved to a state-operated group home in February, but only after the lawsuit was filed.
According to the complaint, Kathleen was over-medicated in a provider-run residence with Depakote and Risperdal, drugs for bipolar disorder; however, that diagnosis of bipolar disorder later turned out to be mistaken. The suit alleges that DDS’s failure to move Murphy to a state-run facility coupled with its failure to provide people waiting for DDS care with the option of state-run residential care violate federal laws. Those laws include the Home and Community Based waiver of the Medicaid Law (42 U.S.C., Section 1396), which requires that intellectually disabled individuals and their guardians be informed of the available “feasible alternatives” for care. In addition, the complaint alleges that the state is violating the federal Rehabilitation Act (29 U.S.C., Section 794), which states that no disabled person may be excluded or denied benefits from any program receiving federal funding.
DDS’s projected number of transfers to provider residences didn’t materialize
In 2009, DDS projected that a substantial number of former developmental center residents would choose provider-run residential care. In its Community Services Expansion and Facilities Restructuring Plan in 2009, DDS projected that slightly more than half of a then estimated total of 402 developmental center residents would be transferred to provider-run group homes. In other words, DDS was projecting a major increase in the number of clients living in provider-run residences — a situation that would result in millions of dollars of additional state revenue to the providers.
As it turned out, the 47 former developmental center residents who actually transferred to provider-run residences was 77 percent fewer than the 206 that DDS had projected. The number of residents who actually transferred to state-operated group homes (156) was 39 percent higher than what DDS projected in 2009, and the number that transferred to other developmental centers (169) was more than double what DDS originally projected.
In actuality, things didn’t work out the way DDS and the providers had projected or apparently hoped. Possibly for that reason, it would appear that DDS is continuing to try to maximize the providers’ revenue and business opportunities at the expense of adequate and appropriate care and services for the vulnerable people in the Department’s care. DDS needs to rethink its policies in this regard. At the very least, DDS should let people seeking residential care know about existing vacancies in state-operated group homes. That is after all the law.
COFAR blog 
Note: We received a letter from DDS Attorney Margaret Chow-Menzer on June 20 in response to this blog post, asking us to correct “misleading or incorrect inferences” in it. We stand by the post in its entirety. Our response to Attorney Chow-Menzer’s letter is below:
Elin Howe
Commissioner
Department of Developmental Services
Boston, MA
Dear Commissioner Howe:
I am writing in response to Attorney Margaret Chow-Menzer’s letter to Thomas Frain, dated June 20, in which she asks Attorney Frain to correct “misleading or incorrect inferences” in a June 9 blog post on state-operated group homes. The blog post is published on the COFAR Blogsite at https://cofarblog.wordpress.com/2014/06/09/dds-expands-privatized-services-despite-family-preference-for-state-care/.
While Attorney Chow-Mezer’s letter is addressed to Attorney Frain, it was mailed to me; and, given that I am the author of the blog post in question, I am writing to you on behalf of COFAR to respond to Attorney Chow-Menzer’s points. We stand by the blog post in its entirety and disagree strongly with the assertions made in Attorney Chow-Menzer’s letter. We see no reason to make any corrections to the post.
Here are our responses to the specific criticisms raised by Attorney Chow-Menzer about the blog post:
First, Attorney Chow-Menzer takes issue with the assertion in the post that there has been a “strong preference among families and guardians for state-run care.” I based that statement on DDS data that showed that of the 372 individuals who were transferred from developmental centers marked for closure since 2008, 87% chose to move either to state-operated group homes or other developmental centers. Less than 13% chose corporate provider-operated residences.
Attorney Chow-Menzer contends that the 372 individuals represent only 3% of the total number of persons receiving residential supports from DDS. Therefore, she argues, those people are not representative of the total DDS population. She states that 82% of all individuals in 24/7 residential services are in provider-operated residences.
But what Attorney Chow-Menzer does not mention is that the vast majority of the residents of provider-run group homes were never given the choice of state-operated care, as required by the Home and Community Based Waiver (HCBW) provision of the federal Medicaid Act [(42 U.S.C., Section 1396n(c)(2)(C)]. In fact, that is the main point of the post. If state-operated care is not offered to the vast majority of people in the DDS system and they are told that provider-run care is their only option, they are probably going to end up in provider-run residences.
The only people who really had a choice between state and provider-run settings were the 372 former residents of the developmental centers, and they overwhelmingly chose state-operated care over provider-operated care. I would note, by the way, that the post does not say that the DDS data show that everyone in the system prefers state-run care. It says only that the data appear to us to indicate “a strong preference among families and guardians for state-run care.”
Attorney Chow-Menzer’s second argument is that the post draws an apparently erroneous conclusion that there are or have been vacancies in state-operated group homes; although, on a closer reading, it does not appear that Attorney Chow-Menzer is denying the existence of vacancies in the state-ops. The post’s point about vacancies is based on DDS data that since 2008, DDS closed 28 state-operated homes, and 97 out of 99 residents of those homes were relocated to other state-operated homes. Attorney Chow-Menzer says that almost all of those 97 residents moved to new state-ops and not to existing vacancies. But, the post does not say the vacancies were in existing group homes. There were obviously vacancies in the new homes that were filled by people transferred from the state-operated homes and developmental centers that were closed.
Also, in a comment on the Blue Mass Group blogsite, Gary Blumenthal, president of the Association of Developmental Disabilities Providers, said:
“The Governor’s Institutional Closure plan built additional state operated group homes, creating vacancies to support the continued employment of state employees in those new homes so they could preserve their state pensions and state employment” (my emphasis). So, Mr. Blumenthal himself, the DDS’s chief advisor on provider-based care, contends there were vacancies in the state-ops.
The DDS data show the Department built 49 new state-ops since 2008. If there were no vacancies in these homes, why did they close 28 of the homes during the same period? In any event, the post stated only that “there are apparently vacancies in state-operated group homes.” The post does not state this as a fact, only as a possible explanation for the closures of the homes and the relocations of the residents. Moreover, Attorney Chow-Menzer does not address the point in the post that the new state-operated group homes built since 2008 appear to have been intended to accommodate only the residents transferred from the developmental centers.
Finally, Attorney Chow-Menzer contends the post draws an “unfounded characterization” that DDS has placed a priority on boosting funding and resources to corporate providers. The post’s claim is based on the fact that the governor’s proposed Fiscal Year 2015 budget would result in an increase in the provider residential line item of almost 17 percent in inflation-adjusted terms, more than double his proposed 6.5 percent increase in the state-operated residential line item.
Attorney Chow-Menzer argues that the claim of a priority on provider-run care “is totally baseless” because the governor’s proposed increase in the provider line item “reflects the Department’s implementation of Chapter 257 of the Acts of 2008,” which set new reimbursement rates for the providers. In other words, the administration is just following the law, not expressing a preference for provider-operated care over state-run care.
Attorney Chow-Menzer is correct that the governor’s proposed increase in the provider line item is due to Chapter 257, but what she does not say is that Chapter 257 has been a priority of the providers and was enacted, and will now apparently be fully funded, as a result of their relentless lobbying. To say the Department is just following the law would seem to beg the question. The corporate providers use state revenue in part to amass huge executive salaries and other forms of executive compensation. They have a direct financial interest in the implementation of Chapter 257, and the Department has worked hand-in-glove with the providers in furtherance of that financial interest.
In sum, Attorney Chow-Menzer’s letter does not identify any incorrect statements in the post, in our view, and it fails to address the major questions raised in the post, including the question why DDS would build new state-operated homes and at the same time close existing homes, and moreover, why close these homes while people are waiting for residential placements? And, as noted, her letter does not address our main point that most people in the DDS system are not given the choice of state-run care, as required by state and federal law.
We would welcome constructive dialogue with the Department about these issues, but Attorney Chow-Menzer’s letter, unfortunately, does not advance that possibility.
Sincerely,
David Kassel
Communications Director
Massachusetts Coalition of Families and Advocates (COFAR, Inc.)
http://www.cofar.org
112 West Bare Hill Road
Harvard, MA 01451
Phone and fax: 978-456-3230
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I am the sister of a intellectually disabled person currently living in a private residential group home. Over the years our family has noted many problems with the private system. There is now an open investigation regarding an incident that recently occurred. Our sister needed three surgical operations to repair her injuries. We have no answer yet as to what happened but are very concerned with the private business and how they manage and train their staff. This is the second investigation that has been opened regarding our sister. The first one was due to a severe sunburn that required hospitalisation. When our sister was under the care of the state, before deinstitutionalisation, there were no such incidents. I fully support your thoughts that state run facilities provide more training and better pay, which will promote better care for the residents.
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March 18, 2019 I am new to this blog.
Ditto + on all of the above writing. I, too, am a sister of an intellectually, brain injured person. She suffered a Bacterium infection from bug bites while living at an ABI 24/7 residence privately operated with funds from DDS. In October, 2018 she was sepsis and hospitalized for 15 days and than again within 2 weeks for 3 more days. She is still being treated by an infectious disease doctor and still taking antibiotics. We just received the CMS summary which totaled over thousands of dollars. Cutting the budget for care that works is not the answer. So much waste in these private group homes paying for these houses and staffing with unqualified people is not only harmful for our loved ones but a waste for taxpayers. Shame on the system. There is no accountability in these private homes provided with DDS funds. We also have reported to EOEA and DPPC on 4 different occasions of harmful incidents and still have not received any investigation reports or findings.
I was never in favor of institutionalization however the bar has to be raised in monitoring and accountability for these corporations that operate these homes. They get away with in my opinion, murder!
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You are absolutely right, the care and treatment in privately run care homes can be dangerous due to unqualified staff, lack of training and supervision, and no accountability of the managers that accept DDS funds. My sister has been in private care since the start of deinstitutionalization. She has been hospitalized at least 3 times due to negligence at the private care home. The last incident caused a severe fracture to her elbow, shattering all three bone heads. Three surgeries were needed to repair the elbow joint. At this point, we fought to have her removed from the private care facility into one that we would choose. The management at the private care home denied any responsibility for my sister’s injury, became extremely rude and indignant. We raised a complaint with DDS, documented the incident with DDS and when the case was completed by DDS, they found no fault with the private care home. We appealed the case to the Commissioner, Elin M Howe and after many, many months were told that they supported the private care home’s account of the incident. It’s totally frustrating to see that no matter what happens in these homes the patient’s rights seem to be overlooked for the benefit of the private corporations that work with DDS. Our sister spent one year in a nursing home recovering from her injuries but thankfully we were able to find another care home, that is set up for older, residents with medical needs. A family member visits once a week, she maintains constant communication with the staff, observe the home for cleanliness and checks the refrigerator for quality and amount of food in place. In the last home, we discovered on a visit that there was no food or fluid in the refrigerator. When we spot something that does not look right, we now speak directly with the staff and make sure it’s documented. Through our years of experience with DDS and the private care industry we now understand that constant supervision of the care providers needs to be checked by family members if possible. Someone needs to protect the rights of these residents and as we have found, it is not always provided for by DDS.
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