Are they really cutting that program?
“I want to shake you all,” the woman said through an interpreter.
It was a plea to the impassive panel before her of members of the House and Senate Ways and Means Committees, none of whom could really have more than an inkling of what it must be like to live, as this person does, with both deafness and blindness.
I didn’t catch the name of the woman, who testified at a hearing on the state budget in Gardner auditorium at the State House on March 9. But her message was clear. She wanted to stop the yearly cycle of budget cuts that continually threaten her lifeline to the outside world.
Specifically, she was referring to the proposed elimination in Governor Patrick’s Fiscal Year 2013 budget of $450,000 for a program to provide her and other deaf and blind people with community-based support services. Yes, $450,000 for a program to provide interpreters and other assistance in daily living to people who are both deaf and blind. It’s apparently something this administration can’t bring itself to support, despite its claim to be a pioneer in developing community-based services for the disabled.
“Can you imagine being deaf and blind and trying to go food shopping without any help?” the woman asked the committee. “If this program is eliminated, I will be suicidal.”
Apparently, some of the members of the Ways and Means panel were beginning to imagine that. There were expressions of assurance that the funding for the program will be found. Representative Martha Walz of Boston, a member of the House Ways and Means Committee, responded that “it is the governor who proposes to cut these programs every year and the Legislature that restores it year after year.”
March 9 state budget hearing before the House and Senate Ways and Means Committees
But even if the Legislature restores the $450,000, the promise of “Community First” will be far from realized, even for the estimated 500 people in the state who are both deaf and blind. Chris Emory, a member of the deaf-blind community, maintained that the program in question is able to provide services for only about 70 of those people.
(By the way, the administration committed $45.8 million to the Community First Initiative for FY 09, and termed it the first year of funding under this initiative. I haven’t been able to find any subsequent appropriations under that line item.)
Also testifying at the March 9 hearing was David Berkeley, who urged that the Legislature add $7 million in funding for “clubhouses” that provide a range of community services to people with mental illness. Berkley said the program, which has been level-funded by the governor and Legislature for the past 12 years, has kept him from needing hospitalizations for his own disability. Before he received help from the program, he had been hospitalized more than 50 times over an 11-year period, at a total cost of $750,000.
Reva Stein, executive director of the Massachusetts Clubhouse Coalition, said the flat funding for the program has, in effect, amounted to a budget cut because the clubhouses serve 1,200 more people than they did just seven years ago. The Clubhouses offer a wide range of services to the mentally ill, including job training, employment placement, benefit counseling, housing support, homeless prevention, and social opportunities, according to a Coalition fact sheet.
According to testimony at the hearing, the governor’s budget would provide additional funding to the Department of Mental Health for residential services, but the money would be earmarked only for people being transferred from Taunton State Hospital, which has been targeted by the administration for closure.
Similarly, the governor’s budget provides additional funding for community residential services for intellectually disabled people being transferred from four developmental centers targeted for closure. Other community-based programs would be level-funded or cut, however.
I delivered testimony to the Ways and Means panel on behalf of COFAR that time is running out on the Fernald, Templeton, Monson, and Glavin developmental centers. The number of residents left in them has been reduced from roughly 475 in 2008 — when the administration first announced they would be closed — to about 165 today. Yet, no independent cost analysis has ever been done of the closures of those facilities.
It so happens that a bill (H. 3964) requiring such an independent analysis of the costs of closing three of the developmental centers — Templeton, Monson, and Glavin — is currently before the House Ways and Means Committee. The bill was sent to the committee last month after having sat in the Children, Families, and Persons with Disabilities Committee for more than a year.
These developmental centers provide a safety net for a small segment of the state’s intellectually disabled population that cannot function successfully in community-based group homes. Even the Association of Developmental Disabilities Providers, which represents state contractors that operate the group homes, acknowledges that the closures of the developmental centers have so far not produced promised fiscal benefits to the community-based system of care.
I said all of this to the members of the House and Senate Ways and Means panel. They listened impassively, as they had to everyone else. But when I was done there were no assurances provided and no questions.
I was left thinking that the Legislature in this state will indeed often find the money to undo some of the most egregious damage caused by the administration in care for our most vulnerable residents. But it is essentially a Band-Aid solution. The Legislature appears less interested in addressing or questioning the overall policy this state has been following of cutting and privatizing vital human services.
Dying, intellectually disabled man sent home twice from hospital
The disabled are often treated as second-class citizens, even in hospitals, says Dorothy O’Rourke.
O’Rourke is concerned that may have been the case with a resident of a state-operated group home in Chelmsford. The 51-year-old man, whose name is being withheld, died earlier this month after having been taken twice in two days to Lowell General Hospital and sent away each time, apparently without any significant treatment.
The man had been having difficulty breathing and was sweating profusely when he was taken to the hospital on both February 6 and 7. He died, apparently en route to the hospital, after the group home staff called an ambulance for the third time on the afternoon of February 7.
The cause of death is listed on the death certificate on file in the City of Lowell as acute respiratory failure and aspiration pneumonia, which can indicate choking. A death report form filed with the Disabled Persons Protection Commission, however, states that the man died after experiencing cardiac arrest.
Despite the possible discrepancy in the stated causes of death, the Chief Medical Examiner’s Office declined to do an autopsy, and the man’s remains were cremated. He had lived in the same group home as O’Rourke’s son.
O’Rourke strongly defends the staff of the group home, which is managed by Northeast Residential Services, a division of the Department of Developmental Services. “The staff there are wonderful,” she maintains. “They did all they could for him, including performing CPR. It’s the hospital that kept sending him home. I thought they would have at least kept and monitored him. I don’t understand it.”
O’Rourke has no information about what actually happened in the hospital after the man was taken there on each occasion. But she maintains that many hospitals are ill equipped to deal with intellectually disabled people, particularly those who are non-verbal, as this man was. “I think hospitals tend to ignore the mentally disabled,” she said. “I think they may need a special unit to handle mentally disabled people.”
A spokeswoman for Lowell General said the hospital would have no comment on the case due to privacy issues.
According to sources, the man had been sent to his day program in Lowell on the morning of February 6, and the staff at the day program made the first call to 911 to take him to the hospital. A Lowell Police Department official said a squad car was sent to the day program site at 8:30 a.m. in response to a call about a male having trouble breathing. (A police car was dispatched in addition to an ambulance each time, and the man was accompanied by a staff member to the hospital each time.)
The hospital released the man shortly after his arrival, however, and sent him back home. The following morning, the man reportedly looked exhausted and “out of sorts,” and the group home staff made a decision not to send him to his day program that day. By about 8 a.m., the man was slumped over in his wheelchair and sweating heavily, a source said. A group home staff member called 911 shortly afterward. A Chelmsford Police official said a squad car was dispatched to the residence at 8:30 a.m.
However, once again, the hospital made a decision to send the man back to his home. The DPPC report form on the death states that the man had been observed at the hospital on the morning of February 7 to be sweating profusely, but his vital signs were good when he arrived. According to the report form, the man was sent home with a prescription (the name of which was redacted).
By the time he was back at the group home, he was leaning over the side of his wheelchair and was “sweating terribly,” a source said. After the staff noticed the man’s lips turning blue, they immediately called 911 again. A staff worker couldn’t find a pulse.
The DPPC death report states that shortly after arriving back at the group home, the man began to vomit and then lost consciousness, and that the staff began mouth-to-mouth CPR until the paramedics arrived. According to the Chelmsford Police Department, a squad car arrived at the house at 1:45 p.m. The group home received a call from the hospital later that afternoon that the man had died.
The man was formerly a resident of the Fernald Developmental Center. His case is the third we have heard about in which a former developmental center resident in his 50s died suddenly at a state-operated group home managed by Northeast Residential Services. In this case, however, there doesn’t seem to be any indication that the group home was in any way at fault.
“The staff did a tremendous job,” one source said, echoing O’Rourke’s assessment. “They did exactly what they were trained to do. “They jumped right in and did their best to save his life.”
“We hope the DPPC does a thorough investigation of this case,” said Colleen Lutkevich, Executive Director of COFAR, a statewide, family-supported nonprofit organization that advocates for persons with intellectual disabilities and their families and guardians. “If indeed this hospital was at fault in failing to treat this man adequately, we need to find out why. In particular, we need to know whether his disability played a role in the apparent lack of care he received.”
It’s budget time — time to blame the Fernald families
The Massachusetts human service vendors are at it again — blaming the families of Fernald Developmental Center residents for the state’s budget problems.
In an online email to members this week, Gary Blumenthal, president of the Association of Developmental Disabilities Providers, once again resorts to misleading statements about Fernald’s operating cost in order to stick it to family members and guardians of the 14 remaining residents there.
Here’s what Blumenthal says about the Fernald families in his message, which discusses a $10.2 million supplemental bill filed by the Patrick administration to keep Fernald operating:
While the state is still intent on closing Fernald and three other state institutions, the final closure date is uncertain as the last 14 families attempt to hold out, hoping against reality that they can force the state to reverse it’s closure decision.
Despite the families being offered “equal to or better services” per federal Court Orders, the last Fernald families are using every available delay option available, urged on by anti-closure ideologues who still think they can force the state to leave Fernald open for the lifespan of the remaining 14 individuals.
First of all, through their own volition, these families are exercising their legal right to prevent what they see as the unjust eviction of their loved ones from their long-time home.
Moreover, in at least three of the 14 cases, administrative judges in the Patrick administration itself have ruled that the guardians demonstrated that care would not be better in the new locations proposed by the Department of Developmental Services for those residents.
That’s why these cases have dragged on. The administrative judicial decisions have been taken to state Superior court by both the administration and the 11 guardians who didn’t win their administrative appeals. That is their legal right. But Blumenthal and the ADDP have choosen to castigate the families and unidentified “anti-closure ideologues” for somehow bringing the state to its knees fiscally.
We suppose Blumenthal is referring to COFAR as an anti-closure ideologue. It’s true that we oppose the administration’s planned closures of Fernald and three other state developmental centers, which we believe provide critically needed care to some of the state’s most severely and profoundly intellectually disabled residents. But who are the real ideologues here?
We recognize the importance and need for community-based care for the majority of people with intellectual disabilities in Massachusetts. What we have long argued is that the developmental centers are a necessary part of the continuum of care. It is the ADDP and their state-funded vendor members who are the pro-closure ideologues. They argue that the state should abdicate its responsibility of caring for its most vulnerable citizens and hand the entire business over to them.
In furtherance of this aim, Blumenthal has to bend himself into a pretzel logic-wise, and, as we said, make misleading statements about Fernald’s operating cost. He implies in his message that if Fernald were closed immediately, the $10 million in supplemental funding would somehow be re-invested in the community system of care.
Yet, in the same message, Blumenthal admits what we’ve been saying for years — that the state has “reneged” (his word) on its longtime promise to re-invest funding from the developmental centers into the community system. Thus, Blumenthal knows full well that were Fernald to be closed tomorrow, that $10 million would not be invested in the community. The money, or a good portion of it, would follow the residents themselves to their new locations, wherever they might be. The community system as a whole would not benefit in any way.
Further, as they do every year at budget time, Blumenthal and the ADDP single out Fernald and discuss how the per-resident cost there has “skyrocketed.” It’s true that cost has skyrocketed. But what Blumenthal doesn’t say is that’s what happens when you drastically reduce the population of a care facility. The fixed costs get spread out over a smaller and smaller base of residents.
Despite the photo of an abandoned building at Fernald rising out of the weeds that runs atop his message, Blumenthal erroneously makes it sound as though the remaining residents are living the high life because the cost per resident there has risen. As one of the 14 guardians wrote in an email in response to Blumenthal’s message:
Based on what he (Blumenthal) has to say about the “evil 14”, you’d think we were having a blast, loads of fun and just a grand old time!
Also, just once I’d like to see a picture of one of Fernald “homes” like Malone Park or a cottage, or our beautiful chapel, not a building that hasn’t been occupied for 35 years!
You’d think I be use to this by now, but I guess not.
DDS vendor executives not sharing the pain of their workers
Direct-care workers in the state’s contracted human services system have seen their wages stagnate in recent years, but the executives who run the largely nonprofit contractor agencies that employ those workers do not appear to have been feeling that same pain.
We examined compensation to both CEOs and direct-care workers in a sample of 30 service vendors to the Department of Developmental Services, both large and small, from around the state in Fiscal Years 2008 and 2011. This information is available in Uniform Financial Reports, which are submitted to the state Operational Services Division by the vendors and are posted online by the OSD at www.mass.gov/ufr.
The CEO compensation of our sample increased by an average of 16.6 percent during the four year period while the direct-care salaries decreased by an average of 2.17 percent during that time. (See Vendor Compensation Table.)
Among the 30 vendors, the average CEO compensation in FY 08 was $197,068. It increased to an average of $229,872 in FY 11. In FY 08, the average direct care salary for the sample was $33,508. It decreased to $32,780 in FY 11. In FY 11, direct-care workers were earning an average of 14 percent of what the CEOs of those vendors were earning, down from 17 percent in FY 08.
Among the sample, nine CEOs received compensation increases in the four year period reviewed while the direct care workers employed by those same vendors actually saw their wages cut. In two of those cases, the CEOs received increases exceeding 100 percent.
That many CEOs have taken hefty pay increases and the direct-care workers have gotten little or nothing, or in many cases decreases, raises questions about repeated calls from the vendors to add $28 million to a state budget reserve fund to increase those direct care salaries.
If the Association of Developmental Disabilities Providers and its member vendors are really concerned about their direct-care workers’ pay, why have these companies given raises only to their CEOs? Should the state be called upon to bear the entire burden of raising direct-care wages?
“The vendors appear to have it in their own power to give their direct-care workers increases, but they’ve chosen not to,” said Colleen Lutkevich, COFAR executive director. “Instead, they’re looking to the Legislature.”
If the Legislature does step in to fund the direct-care salary reserve account, it will not be at the urging of Governor Patrick. Despite the ADDP’s appeals, the governor’s budget for the coming fiscal year proposes zero for the reserve fund.
Note: We were not able to use data from one of the vendors, Massachusetts Mentor, Inc. Massachusetts Mentor is a subsidiary of NMH Holdings, Inc., a for-profit corporation that provides residential and other services for intellectually disabled persons in 36 states. NMH Holdings was incorported in Delaware, according to its audited financial statements, though it actually appears to be headquartered in Massachusetts. (NMH Holdings appears to be referred to as The Mentor Network on its national website.)
Massachusetts Mentor’s UFR and other reports filed with the state OSD employ what appears to be an unusual method of listing only partial salaries of top executives. The compensation listed is apparently the amounts of the executives’ salaries that are attributed to Massachusetts. For instance, total compensation for Edward Murphy, CEO of both Mass. Mentor and The (national) Mentor Network, was listed as only $14,830 in FY 10, in a filing with OSD). (The company does not appear to have filed a UFR report in Massachusetts for FY 11.) Murphy is a former commissioner of both Mental Health and Youth Services in Massachusetts.
Greg Torres, chairman of the Board of Directors for both Mass. Mentor and The Mentor Network, earned a total of $2,484 in compensation in FY 10, according to the OSD filing. Torres, a former chief of staff of the Massachusetts Senate Ways and Means Committee, is also currently president of MassINC, the nonprofit civic think tank in Massachusetts that publishes CommonWealth magazine. (CommonWealth frequently advocates for more transparency in governmental finances and operations.)
Also working for Mass. Mentor is Gerald Morrissey, a former commissioner of DDS in Massachusetts. Morrissey’s total compensation as a vice president at Mass. Mentor was listed in the FY 10 OSD filing as $5,113. None of these clearly partial compensation listings could be reliably compared with other CEO and direct-care compensation in Massachusetts.
NMH Holdings earned more than $1 billion in revenues in FY 10, according to filings with OSD, while Massachusetts Mentor took in $3.7 million from DDS and $19.4 million from the Department of Social Services in FY 10, according to its UFR report.
Calls and emails to OSD with questions about Mass. Mentor’s and NMH Holdings’ partial compensation listings for their executives were not returned.
Gov’s budget continues the cuts
With a few exceptions, Governor Patrick’s proposed budget for the coming fiscal year, which he unveiled last week, appears to continue the trend in recent years of cutting funding for care for the intellectually disabled.
We see little to change our longstanding contention that the Department of Developmental Services community-based system, in particular, is not benefiting from the closures of four developmental centers. A few years ago, Health and Human Services Secretary JudyAnn Bigby promised that as a result of the phasedowns and closures of the Fernald, Monson, Glavin, and Templeton developmental centers, some $45 million a year was going to be plowed back into the community-based system of care.
There’s no question but that the developmental centers line item (5930-1000) has been cut deeply as the state facilities have been phased down in recent years. Under the governor’s FY 13 budget, this line item would be cut by an additional $20 million next year, a 13.1 percent reduction. This brings the total cuts in funding for the developmental centers to $55 million since FY 09.
But that found money does not appear to have benefited key community-based accounts such as Adult family supports, Turning 22, and the Salary Reserve to increase the static wages of direct-care human services workers in the community system.
First, let’s look at what would be increased in the governor’s FY 13 budget proposal for DDS and related accounts:
- The Community Day and Work line item (5920-2025) and the previous Transportation line item (5911-2000) would jointly be increased by $9.6 million under the governor’s proposal over current year spending. It’s hard to compare these line items with last year, however, because they have been merged together for some reason in the governor’s budget for next year. The Massachusetts Arc and the Association of Developmental Disabilities Providers are saying that the transportation component of the new line item is “short” by $3.1 million. We’re not exactly sure what they mean by that.
- The Community Residential Supports line item (5920-2000) would be increased by $31.6 million or 4.2 percent, while the State-Operated Group Home line item (5920-2010) would be increased by $12.9 million or 7.8 percent. As we understand it, however, the increases in these line items are intended primarily to accomodate residents being transferred from developmental centers targeted for closure. It’s unclear that anyone else in the community system will benefit from the increases. The Arc/ADDP are saying the state-operated group home account is still “short” by $4.1 million. Again, not sure what they mean.
- The DDS Administrative line item (5911-1003) would be increased by $2 million or 3.4 percent. This line item funds service coordinators, who arrange for services for clients in the community system. But it’s not clear whether there would be any benefit in that increase to the service coordinators, who have faced layoffs in recent years as their caseloads have skyrocketed. According to SEIU Local 509, a state employee union, the $2 million increase will cover negotiated salary increases within the DDS administration as well as office rental increases, while essentially level-funding staffing.
The rest of the DDS and DDS-related line items appear to be either cut or level-funded, which amounts to a cut relative to inflation. They include the following:
- The Adult Family Supports line item (5920-3000) would be cut by $5.5 million or 11.8 percent. This comes on top of cuts totaling 26.9 percent since FY 09. Those cuts were only partially restored last year through supplemental funding. The governor’s FY 13 proposal would wipe out that restoration. We’re not sure why this account always gets cut so badly because it would provide funding for families to keep people at home, which was a critical component of the governor’s Community First initiative, as we understand it. The Arc/ADDP are saying this reduction will hurt 2,000 families.
- The Turning 22 line item (5920-5000) would be level-funded at $5 million. This program has been cut by $2.7 million since FY 09. The ARC/ADDP are saying the program needs $10.5 million (more than double its current appropriation) to fully serve 710 additional intellectually disabled students expected to graduate from school next year.
- The Autism line item (5920-3010) would be essentially level funded at $4.6 million next year.
- The Salary Reserve line item (4000-0017) to boost the pay of direct-care workers would once again receive zero in funding under the governor’s FY 13 budget. The Arc/ADDP are calling this situation “devastating.”
- The Department of Education/DDS line item (5948-0012) would be cut by $50,000 from current-year spending. This is a joint program for youths with disabilities.
- The Massachusetts Rehabilitation Commission Supported Employment line item (4120-3000) would be cut by $369,400 or 15.1 percent.
- The Massachusetts Day Habilitation and Adult Foster and Family Care accounts (4000-0700), which are funded by MassHealth, would be “funded at maintenance,” according to the Arc/ADDP. This appears to mean that these programs would be maintained at their current levels next year. They have both been sharply cut in recent years.
The bottom line line is that while the administation has seen the need to continue its policy next year of cutting a wide range of community-based programs for the intellectually disabled, it hasn’t helped matters with its single-minded policy of closing the developmental centers. Not only hasn’t the closure policy provided more community-based funding, but it has clearly delayed community-based placements for thousands of people waiting for that care.
DDS stonewalling on cost, care information
(Part 2 of 2-part series on transparency issues in the Patrick administration)
The Patrick adminstation contends it is striving to be “transparent” in the way it conducts the public’s business, and touts its Open Checkbook website among other initiatives.
But when it comes to getting public information from individual agencies within the administration, the record of transparency doesn’t always live up to the billing. We think our own recent experience with the Department of Developmental Services is a case in point.
We’ve been fighting with DDS for several years over public information requests, but the agency’s disinclination in recent months to provide requested information seems to have gotten worse.
It now takes months to get even the most minimal public records in response to our requests. And DDS recently cited the letter of the Public Records Law in claiming they have no obligation to answer any questions about records that they have provided to us. Also, in two cases in the past year, DDS cited confidentiality requirements in refusing to release what we think, in at least one of the cases, are clearly public documents.
Meanwhile, even a state lawmaker has been unable to get information out of DDS on deaths in the agency’s system. State Rep. Anne Gobi, a Democrat from Spencer, wrote to DDS Commissioner Elin Howe in mid-October, asking for information on the number of residents who had been transfered from the developmental centers to community-based group homes and how many of those residents had died after the transfers. As of this month, Gobi’s staff said she had not received any response to her inquiry.
Here are some more details about our efforts to get records and information from both DDS and the Executive Office of Health and Human Services:
- In October, COFAR submitted a request similar to Gobi’s to DDS for information and public records concerning the number of developmental center residents who have been transferred to group homes since 2008 and the number of those residents who have died.
In that request, COFAR also asked for the number of community-based group homes that have been built to house former developmental center residents. In early November, a DDS attorney responded that the agency was in the process of searching for the requested records. There has been no further word since then. We wrote to DDS on January 17, seeking an update on the status of our request, but have received no response to it.
- In October, the DDS general counsel denied a request COFAR had first made in July for records detailing the costs of medical, nursing, clinical, and therapeutic services for individuals in a group home program operated by the May Institute, Inc.
COFAR initially filed the request for the records concerning the May Institute with both DDS and EOHHS. In August, an EOHHS official responded that that agency was in the process of searching for the records. Then, in September, a DDS attorney stated that DDS was searching for the same documents.
There has been no further word from EOHHS since August regarding the records. In October, however, the DDS general counsel appeared to reverse the Department’s September position by stating that documents detailing funding for medical or clinical services for individuals would be part of their individual client records and therefore exempt from disclosure under the Public Records Law.
COFAR appealed the denial to the Supervisor of Public Records in October, suggesting that DDS redact any names or any other information that might identify individual clients. In the October appeal, COFAR maintained that it was seeking only to find out the total cost to taxpayers of care for community-based clients such as those in the May Institute program. Should DDS refuse to provide that information, “the public will have no way of knowing basic details about the provision and funding of these kinds of public services,” COFAR’s appeal added.
To date, the Public Records supervisor has not ruled on COFAR’s appeal.
DDS similarly denied a request in July from COFAR for information about the death of a man in a group home earlier that month, four days after he had been transferred there from the Templeton Center. In that case, the Public Records Supervisor upheld DDS’s denial, accepting the Department’s argument that the information was private.
- In July, COFAR asked DDS for detailed budgetary information regarding the Monson, Templeton, and Glavin developmental centers, which have been targeted by the administration for closure. In response, DDS in August provided only a single line item amount for each facility, representing the total spending for that facility. There was no budgetary breakdown of the line item for any of the facilities.
After COFAR appealed to the Public Records Supervisor, DDS, in late October, provided an “aggregated” spreadsheet containing numerous line items for all three developmental centers. However, this time there was no separate breakdown for each facility. Moreover, the total aggregated spending amounts for each of three fiscal years in the October response did not correspond with the totals provided in the August response.
As a result, COFAR sent an email to DDS asking why there was such a big difference, in particular, between the $176.3 million in total spending listed in the October spreadsheet for the three facilites in FY 2009, and the $57.8 million listed in the August response for the same three facilities.
In a letter sent to COFAR in response, a DDS assistant general counsel wrote that the agency “is not required to answer questions…” under the Public Records Law. So much for letting us, and the public, in on the inner workings of the state’s finances.
Earlier this month, an attorney with the Public Records Division, sent us a nice email, apologizing for the delay in responding to our October appeal regarding the May Institute documents, and saying:
I know that you are working very hard to help those in the Commonwealth who are the most in need, and that receiving records from custodian’s, like DDS, is a crucial part of assisting those individuals.
Now, if only DDS wouldn’t balk at simple requests for information, and showed a dedication to following through on the administration’s claims of transparency.
Open Checkbook could be more open
(Part 1 of a 2-part series on transparency issues in state government)
Despite its promises of greatly increasing government transparency, the Patrick administration’s new Open Checkbook website seems to me to fall a little short of the hype.
Open Checkbook was launched in December with lots of claims made about how it was going to give the average Internet user a powerful new lens into the inner workings of public finances. The state budget office in conjunction with the Comptroller and Treasurer jointly instituted the website in response to legislation that sought to upgrade the state’s relatively low ranking in a state-by-state transparency survey by MassPIRG.
Open Checkbook is divided into two major sections, State Vendor Spending and Payroll & Pension Spending. I found the vendor spending section to be disappointing in one major respect. It displays a lot of about where the money to vendors comes from, which is very good, but no information on where the money goes, i.e., how the vendors spend it. (I haven’t yet tried out the Payroll & Pension Spending section.)
I used the vendor portion of Open Checkbook to look up one specific company, the May Institute, Inc., for Fiscal Year 2010. This is the same nonprofit provider for which COFAR has unsuccessfully sought cost information lately from the Department of Developmental Services.
I clicked on one particular category of funding for that vendor and got a long list of dates followed by payment amounts. By clicking on July 14, 2009, for instance, I was able to find out that DDS paid the May Institute $367,000 on that date for residential and day services. It doesn’t appear to be possible to find out much more detail about that payment.
What is good is that I was able to do a refined search, based on the residential and day services account, and find that a total of $26.9 million was paid to the May Institute under this account by DDS in FY 2010.
The bad news, as noted, is there is no way to track where the money goes after it gets to the vendor. For instance, there there appeared to be no way to view administrative expenses for the May Institute or to find data on the compensation of executives of the agency. It would seem that a checkbook should tell you about both incoming and outgoing funds.
Also, the site doesn’t display contracts, as some similar state sites do; and the data on Open Checkbook doesn’t go back before Fiscal Year 2010. An official with the state budget office said displaying actual contracts is “on our list” for improving the site, but that hasn’t been decided yet.
It’s also worth noting that much of the information available on Open Checkbook is available as well on the state’s longstanding Uniform Financial Report website for vendors. In fact on the UFR website, you can find total payments to vendors broken down by government agency as well as spreadsheets that do show where the money is going, including amounts paid to executives of the vendor agencies. (That salary information may be incomplete, in several cases, as we have reported. But at least some of it is available.)
The UFR site, for instance, shows that a total of $30.29 million was paid by DDS to the May Institute in FY 2010 as part of a total of $104.4 million in revenue to the vendor. Admittedly, the information on the UFR site isn’t nearly as up to date as the Open Checkbook site. But you can find a lot of information on the UFR site that isn’t available on Open Checkbook, such as the fact that the May Institute had $101.6 million in expenses in FY 2010, including $396,716 in compensation to its CEO and $56 million on direct care salaries. Also the UFR information goes back to FY 2002.
What the UFR site doesn’t appear to show, which Open Checkbook does, is a breakdown of funding going to vendors per budgetary account, such as the Residential and Day Services account.
One other problem I had with Open Checkbook has to do with its presentation of a large amount of abbreviated or otherwise highly techical information. For instance, the the funding listed for the May Institute was broken down into five categories on the site, including Grants to Nonpublic Entities, Legal Support Services, Medicaid, Purchased Human and Social Services for Clients/Non Medical, and a fifth and largest category dollarwise, titled “PurchH&Ss For Clit.Med/HC Rel (MM3).” Spending under this category was listed as $23,047.235.83. What exactly does “Clit.Med/HC Rel (MM3)” stand for?
I was able to hover my cursor over the acronym, and up came the following definition, which didn’t clear up the confusion very well. The definition was:
Payments pursuant to contracts with organizations to purchase social services or programs with medical or healthcare related components on behalf of specifically identified clients or a specific target group. Includes services rendered by an individual with payment to a corporate entity. Federal funds are reported as sub-recipient payments.
The “MM3” part of the acroym is an object code classification for the payments. The Open Checkbook site FAQ page states that individual object codes are defined in the “Expenditure Classification Handbook” maintained by the Comptroller’s Office. But unfortunately, the link on Open Checkbook FAQ page to the Comptroller’s Handbook didn’t work.
As administration officials have said, Open Checkbook is a work in progress.
Alleged assaulter of disabled man is a no-show on trial date
Sheila Paquette’s long-running quest to bring the man who allegedly assaulted her intellectually disabled brother to justice took yet another turn this week.
After months of delay, Monday, January 9, marked the date for the trial of John Saunders, a former care worker in the group home in which Paquette’s brother, John Burns, lives.
The bad news is Saunders was a no-show at Falmouth District Court, to which Paquette and five witnesses in the case had traveled from their homes in western Massachusetts. But Paquette was not deterred or defeated. The good news is that the judge in the case ruled that Saunders had defaulted on his bail and should not be released prior to trial if he is picked up on a violation of any kind.
But Paquette said the judge’s ruling was “a really positive thing for us. If he (Saunders) gets picked up, he’ll be in jail and there is no way he can avoid showing up for trial again.” The question is when, if ever, Saunders will be picked up. Police are unlikely to go looking for someone wanted for allegedly assaulting a disabled man.
Nevertheless, Paquette believes she is proving by sticking with the case that the system can be made to work for crime victims, even when those victims are intellectually disabled. “The state and the public should know that we will take these cases to court,” she said. She said she has started a legal fund to raise money not only to pursue her brother’s case, but to help others pursue similar prosecutions of assaults against people with disabilities. “It’s a difficult process, and I think a lot of people are intimidated by it,” she said.
Paquette said her main concern now is that her brother may have become depressed in recent months and that his condition may be connected to the assault. “It’s one more assault he couldn’t manage,” she said, noting that her brother had been assaulted on two occasions in group homes prior to the alleged assault by Saunders.
Do we really want managed care for the disabled?
Hang Lee struggled to get his words out in testifying on Wednesday morning before a packed public hearing in Boston on a proposal by the Patrick administration to introduce managed care into the delivery of services for the disabled.
Hang said he is concerned that under the proposal, he and thousands of other disabled people who are eligible for both Medicaid and Medicare, will see reduced funding for medical equipment and services they currently need and might need in the future.
Hang suffers from cerebral palsy and scoliosis, debilitating and progressively worsening diseases of the spine and nervous system that he anticipates will leave him completely immobilized in a few years. “I am in constant pain and emotional agony,” said Hang, his face contorted with the effort to speak each sentence.
He said he anticipates he will evenually need a body brace, which costs thousands of dollars. “A cut in services means a reduction in funding for the brace,” he said.
Hang was one of dozens of people, who are dually eligible for Medicaid and Medicare-funded services, who testified at the hearing held by the Executive Office of Health and Human Services. Under the EOHHS proposal, private vendors, known as Integrated Care Organizations (or ICOs) would be hired to manage medical, prescription drug, and disability services to thousands of those people.
Medicaid helps fund a range of residential, employment, and other services for persons with disabilities, while Medicare funds medical care and prescription drugs for many of those same people. The EOHHS maintains that their proposed system would cut costs of care by eliminating overlap, redundancies, and a lack of coordination between Medicaid and Medicare. Medicare and Medicaid will spend a projected $3.85 billion in 2011 on health care for dual eligible adults ages 21-64 in Massachusetts, according to EOHHS.
COFAR and the SEIU Local 509 state employee union called for exempting the management of residential care, day and transportation, service coordination and other services from the proposal. SEIU representative Stu Dickson maintained that while the union “agrees with the need to address needless costs of medical procedures, tests abuse, billing and administrative redundancies, etc., this is profoundly different than the care of human beings.” Dickson contended that in implementing the proposal, Massachusetts would compete with other states in a “race to the bottom” in care for the disabled.
“This proposal appears to be another step in this administration’s quest to privatize key services to the state’s most vulnerable people and to remove government from its responsibilities in that area,” I testified on behalf of COFAR.
Even the human service providers are not sold on further privatization in this area. In a December 16 email to members, the Association of Developmental Disabilities Providers stated that “the Arc (of Massachusetts) and ADDP do not believe there is current research available that validates significant cost savings attained by turning over large parts of State Medicaid programs to managed care companies.”
As did Hang, many in packed hearing on Wednesday said their main concerns were the retention of consumer choice and access once a corporate entity was making decisions on who gets what services.
Other speakers maintained that they had spent years, in some cases, in finding doctors and therapists for their conditions and might lose those specialists under a managed care system. “My doctors all work together,” one woman testified. “My concern is I’m enrolled in a managed care plan and my doctors are not enrolled in it, what do I do?”
“We have to make sure the big corporations don’t just look at the bottom line,” said one man who relies on Medicaid-funded personal care attendants for his disability.
Others called for more planning for oversight of the ICOs, and more accountability. Dale Mitchell of Ethos, a nonprofit provider of services to the elderly and disabled, called for an “independent care management entity” that would oversee the managed care system and prevent it from “chipping away at consumer control and input.”
Victoria Pulos of the Mass. Law Reform Institute said the involvement of consumer-based organizations is needed to establish “accountability systems” to oversee the ICOs. And Laurie Martinelli of the National Alliance on Mental Illness maintained that the “role of families needs to be spelled out” in the EOHHS proposal, in addition to more planning for issues such as transportation of clients.
Let’s hope the folks at EOHHS are listening to all this.
Our question to Secretary Bigby
It was the same story over and over at a public hearing this past Friday, presided over by Secretary of Health and Human Services JudyAnn Bigby.
Speaker after speaker urged Bigby and her panel of EOHHS assistant secretaries and commissioners at the Agganis Arena at Boston University not to cut the budgets of their programs. The hearing room was packed with some 300 people, many of them disabled, and many of them program providers.
Some of those testifying, such as Hang Lee of Multi-Cultural Independent Living Center of Boston and Paul Spooner of the Metro West Center for Independent Living, even urged increased funding for their centers — an additional $1.1 million in each case.
SEIU organizer Stu Dickson (at table) testifies before EOHHS Secretary JudyAnn Bigby at state budget hearing on Friday.
A panel of advocates with the Association of Developmental Disabilities Providers simply asked for the budget cuts to stop. “We ask you to remind the governor (who placed $350 million in the state’s rainy day fund earlier this fall) that it’s still raining,” said Gary Blumenthal, president of the organization. Ten thousand families are without support services from the Department of Developmental Services, among the other results of years of budget cutting, he said.
But it doesn’t seem Bigby will be able to do much to push back against the cuts, much less give Lee and Spooner additional funding, if the governor’s budget people decide to take aim once again, as they’ve done all along, at critical DDS programs. Despite an uptick in state revenues that have brought those revenues back to the levels of Fiscal Year 2008, prior to the nation’s economic meltdown, Bigby stated in a notice sent out prior to Friday’s hearing that:
FY 13 will be challenging and require cuts and reductions and the need for the Administration to make difficult decisions.
Sounds like Administration and Finance Secretary Jay Gonzalez may have already told Bigby to prepare for the worst.
Yet, despite the continuing bad budget news, most of those at the portion of Friday’s hearing devoted to DDS issues still apparently retain the faith that the administration’s plan to close four state developmental centers will somehow rescue them. Several speakers praised Bigby for her efforts to phase down the Fernald, Monson, Templeton, and Glavin centers, apparently hoping that the budgetary “savings” in doing so will be directed to their programs.
Since FY 09, the administration has cut the developmental center line item in the state buget by more than $45 million. But, as I reminded the audience (including Secretary Bigby) when I got my three minutes to speak, we’ve seen no evidence thus far that the community line items have benefited from the cuts in the developmental center account.
Since FY 09, cuts in the community-based accounts include reductions to adult family supports (26.9 percent cut), community transportation (17.6 percent), community day and work (3.8 percent), and Turning 22 (35 percent). As the ADDP has pointed out, direct care workers in the DDS community system haven’t gotten a raise in their relatively meager pay and benefits in four years.
Meanwhile, the list of people waiting for community-based residential care in the state has only grown longer as the administration has transferred residents of the developmental centers to community placements. “Where is the promised expansion of the community system” that was supposed to happen as a result of the developmental center closures? I asked Bigby in my testimony.
Later, I spoke to an EOHHS fiscal executive at the hearing and got no answer to my question from him either.
One of the few at the hearing who understands the extent of the negative impact the developmental center phase-downs have had so far is Stu Dickson, a DDS service coordinator and an organizer with the SEIU Local 509 state employee union. Dickson urged Bigby to restore $5 million to the DDS administrative account, which funds the service coordinators, who arrange for and monitor services for community-based clients.
Dickson later said that despite the ongoing closures of the four developmental centers, DDS has not assigned any additional service coordinators to the community system. The department has repeatedly laid off the coordinators, whose caseloads have grown to nearly unmanageable levels.
Our question to Secretary Bigby and to the opponents of the developmental centers remains: What has the administration done so far, and what will it ever do, to benefit the community system through the developmental center closures?
COFAR blog 