Is Senator Chris Murphy really just fine with this IG’s report on abuse of the disabled?
It’s hard to believe the Inspector General for the U.S. Department of Health and Human Services has come up with a report about abuse and neglect of the developmentally disabled in New York State that doesn’t have any recommendations in it.
And it’s hard to believe that U.S. Senator Chris Murphy of Connecticut, who had asked for the IG investigation, is okay with this report. Well, we don’t really know how he feels about it. We have been unable so far to elicit a comment from his office about it.
The IG took two and a half years to do this report, which was released last September (although we have only now seen it), and the results seem cursory to say the least. Moreover, the methodology the IG used in the 6-page report (that page count includes an appendix on that methodology) seems questionable.
Based on that methodology, the IG essentially found no problems in New York’s group home system. Well, it’s not clear exactly what types of residential facilities were actually examined. More about that and the IG’s methodology below.
We understand that the IG has not yet released additional reports done on Connecticut and Massachusetts, also in response to Murphy’s request. But if those latter reports have employed the same methodology and lack of apparent rigor as the report on New York, we would expect to see similar non-findings and non-recommendations in them.
In March 2013, Sen. Murphy had asked the IG to investigate the privatized group home industry around the country in the wake of major newspaper exposes in both his state of Connecticut and in New York State about poor care and worse in those facilities.
Both The Hartford Courant in Connecticut and The New York Times had found numerous instances of horrendous abuse and neglect (here and here) in the group home systems in those states that resulted in many cases in deaths of disabled people and serious injuries. In case after case, vulnerable and disabled people were found to have been subjected to sexual and other types of assaults, inadequate care, and substandard conditions in facilities with underpaid and poorly trained staff.
As the Times noted in one of its articles, while the staff of these group homes may have been poorly compensated, the executives of the state-funded companies running the homes were often generously paid.
While the privatized group home industry sprang up in response to reports of abuse and neglect in large institutions in the 1970s, the Courant and Times articles, and many similar media exposes in other states, have more recently raised the question whether group homes have become the new warehouses for developmentally disabled people.
To give Murphy credit, he was one of the few prominent elected officials to express public concern about the group home industry in the wake of the Courant and Times exposes. In 2013, shortly after he was elected a senator in Connecticut, he seemed to be outraged by the Courant’s findings, in particular. He wrote a strong letter to Daniel Levinson, the HHS IG. Murphy’s letter opened by stating:
I write to you today to request that you undertake an immediate investigation into the alarming number of deaths and cases of abuse of developmentally disabled individuals in group homes. In particular, I would like you to focus on the prevalence of preventable deaths at privately run group homes across this nation and the widespread privatization of our delivery system.
Citing accounts of abuse and neglect in Connecticut, New York, Massachusetts, Virginia, Louisiana, and Texas, Murphy’s letter added:
These examples and countless others from across the nation are indicative of a larger problem of the race to he bottom in our health care system. Privatization of care may mean lower costs but without the proper oversight and requirements for well-trained staff.
Murphy’s letter to Levinson noted that prior to his becoming a U.S. senator, he had led the charge in the Connecticut Legislature in 2005 to enact a moratorium on conversations of state-run group homes into privately run residences, which are nevertheless publicly funded.
Since 2013, however, Murphy seems to have gone silent on this issue. His office has never responded to queries from us in the past two years about his call for the IG investigation, and we’ve received no response to a call to Murphy’s office last week and to an email this week, asking if Murphy is satisfied with the IG’s work so far.
Our questions and concerns about the IG’s report primarily have to do with the IG’s apparent decision to conduct a much more limited review than what Senator Murphy had asked for. Coupled with the sharply limited nature of the review is what appears to be a vagueness about what was examined. The report doesn’t appear to fully specify, for instance, which types of residential facilities were included in the review.
The report says that the review was limited to Intermediate Care Facilities (ICFs) in New York State in which at least 70 percent of their intellectually disabled Medicaid beneficiaries had an ER visit from 2012 through 2013. This resulted in a review of cases involving 109 persons at 12 ICFs.
ICFs are a distinct category of residential facility for the developmentally disabled. They are required to meet strict federal standards for care under the federal Medicaid statute, and tend to serve profoundly disabled and medically involved people.
The IG’s report stated that New York State has both state-run and privately run ICFs, and that the privately run facilities have less than 30 beds. All that is stated in the report is that the sample of ICFs selected by the IG included two state-run ICFs and 10 privately run ICFs. The report, however, doesn’t say whether any of the ICFs were actual group homes, which tend to have far fewer than 30 beds.
Here is the single finding or conclusion of the IG’s report:
ICFs in New York with high rates of ER visits by intellectually disabled Medicaid beneficiaries under their care reported … these visits, as required, and potential neglect or abuse was reported and investigated (by the appropriate state agencies). However, the vast majority of ER visits we reviewed resulted from circumstances associated with the Medicaid beneficiaries’ underlying medical conditions—not from neglect or abuse. Accordingly, this report contains no recommendations…
In written comments on our draft report, the health department stated that it was pleased that we had no recommendations.
While it’s not surprising the health department is pleased by the lack of recommendations in the report, we would think that, at the very least, taxpayers, who paid for this two-and-a-half-year investigation would have preferred the investigation to have resulted in recommendations. But more importantly, how is it possible that an investigation of a topic of this magnitude and complexity could essentially find nothing wrong? Particularly, when we know there is a lot wrong with the system.
Here are some of the questions we’ve posed to the IG regarding the methodology used in the report: (We’re still waiting for their reply.)
1. Why was the IG review limited to ICFs, when, in fact, many group homes in New York State are not ICFs?
As noted above, it’s not clear how many, if any, of the ICFs examined by the IG actually were group homes. Moreover, the report doesn’t appear to mention the Home and Community Based Settings (HCBS) waiver to the Medicaid statute under which most group homes operate. The waiver exempts those homes from ICF requirements.
New York State does appear to have privately run group homes that operate under the HCBS waiver. Were group homes, which do not operate under ICF rules, included in the review? If not, why not?
2. Could there be an overlooked variable biasing the results as a result of the IG’s methodology? For instance, might a group of ICFs have a high percentage of patients admitted to ERs because those are the ICFs with the most medically fragile patients?
3. Why did the IG look at data for only two years — 2012 and 2013? Shouldn’t the IG have examined data over at least a 10-year period?
4. What about deaths? The review appears to have been limited to outcomes of persons sent to ERs from a sample of ICFs.
Sen. Murphy’s letter to the IG in 2013 specifically requested that Levinson investigate preventable deaths in group homes. In limiting his review to persons taken to ER’s, didn’t Levinson’s study miss deaths in which no one was taken to an ER?
5. Did the investigators interview staff, families etc. in any of the facilities?
One of the reasons we’re so disappointed in the IG’s New York report is that it appeared to be one of the few instances in which the federal government had undertaken an investigation of privatized healthcare. In recent years, state-run care has been a persistent focus of federal investigations, while privatized care appears to have gotten a free pass. Between 2009 and last year, the U.S. Justice Department had filed more than 45 legal enforcement actions in 25 states to limit or shut down state care.
The reason for that apparent bias against state-run care appears to be, in part, an ideology held by the the current and previous administrations against institutional or congregate care, which is primarily state-run. That ideology has become so fervent, in fact, that only the smallest group-home settings are considered acceptable by federal organizations such as the National Council on Disability.
But there has been a persistent drumbeat of information about poor care in these smaller, privatized settings, and a lack of oversight of them. But all the HHS IG has produced so far in response to this drumbeat is a six-page report that has no recommendations. We have to hope Senator Murphy isn’t satisfied with that.
COFAR blog 
This is such poor investigation …. Even a high school student in an introductory research class would receive a low grade. This investigation is downright embarrassing. Do private agencies have such extensive reach that they can influence these efforts? Very disturbing
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Pathetic.
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