Posts Tagged ‘congregate care’

Sheltered workshops being closed in MA despite protective budget language

November 16, 2015 3 comments

Despite the passage of protective language in the state budget last year and this year, the Department of Developmental Services appears to be moving rapidly to shut down all remaining sheltered workshops in the state for people with developmental disabilities.

“Can’t believe after all the hard work so many people put in, it (the workshop closures) is still happening,” one workshop supporter wrote in an email, referring to grassroots lobbying efforts mounted in the past two years to keep the workshops open.

The protective language that was inserted by State Representative Brian Dempsey in the past two years into the DDS community day line item in the budget seemed to be definitive.  The language states that DDS “shall not reduce the availability or decrease funding for sheltered workshops serving persons with disabilities who voluntarily seek or wish to retain such employment services.”

At the same time, however, Dempsey’s House Ways and Means Committee supported the appropriation of $1 million last year and $3 million this year in a separate DDS line item to fund the transfer of people from sheltered workshops to community-based day or employment programs. So, even while the language in one line item has appeared to protect the workshops for those who want to remain in them, the other line item has funded the removal from the workshops of everyone whose guardians haven’t formally objected to moving them to the day programs.

Sheltered workshops around the country have become an ideological target of the federal government and of many states, which contend that the workshops “segregate” people with developmental disabilities from their peers in the mainstream workforce. But many families of the sheltered workshop participants have countered that the programs are fully integrated into the surrounding communities and provide the participants with meaningful activities and valuable skills.

Sheltered workshops provide developmentally disabled persons with a range of assembly jobs and other types of work, usually for a small wage.

In 2013, the Massachusetts DDS and the state’s major lobbying organizations for corporate DDS providers issued a plan to close all sheltered workshops as of last June, and to transfer all of the participants to either DDS day programs or to “integrated individual or group employment at minimum wage or higher.”

Sheltered workshops are defined by the Social Security Administration as “a private non-profit, state, or local government institution that provides employment opportunities for individuals who are developmentally, physically, or mentally impaired, to prepare for gainful work in the general economy. These services may include physical rehabilitation, training in basic work and life skills…”

Integrated employment is defined by the federal Labor Department as “jobs held by people with disabilities in typical workplace settings where the majority of persons employed are not persons with disabilities, where they earn at least minimum wage, and where they are paid directly by the employer.”

Our concern regarding the DDS/corporate provider plan to close sheltered workshops is that there appears to be a limited number of opportunities in Massachusetts for persons with developmental disabilities to find jobs in “typical workplace settings” where the majority of the people employed are not disabled.  Unless and until these integrated workforce opportunities exist in sufficient quantities, we don’t think sheltered workshops should be eliminated as options.

Unfortunately, the state’s attitude concerning care for the developmentally disabled has long been to close facilities that are considered expensive or that otherwise don’t fit an ideological mold, without having a plan or sufficient resources to adequately replace those facilities.

The director of one sheltered workshop program I talked to said that while there hasn’t actually been a directive from DDS to transfer everyone out of his workshop by a particular date, DDS recently indicated that transfer funding had become available and that his workshop should “determine who would move at this time.”

The workshop director said he planned to transfer more than half of the program’s current participants out between next month and March of next year.  While the protective language in the budget would appear to allow the guardians of the workshop participants to object to the transfer plans, the workshop director said no one had yet voiced an objection.  It’s possible, he said, that people will begin to object once the transfers start.  But he said he sensed less resistance among families and guardians to the prospect of leaving his workshop program than was the case two years ago.

One of the existing integrated work settings in Massachusetts is MicroTek in Chicopee, an electronic cable manufacturer. The company employs 130 people, 15 of whom have disabilities, according to Cynthia Piechota, the company’s program director.  Piechota said she knew of only a handful of other integrated work programs in the state.

A workplace program that is smaller than MicroTek, but similar to it, is Interface Precision Benchmarks (IPB) in Orange, where six people are employed in manufacturing electronic cables. The IPB workforce is currently divided evenly between disabled and nondisabled employees (3 disabled and 3 nondisabled); thus it’s not clear that IPB actually fits the Labor Department’s definition of an integrated workplace.

Ed Orzechowski, whose sister-in-law, Carol Chunglo recently retired as an IPB employee, said he and his wife, Gail, “can’t say enough about what a positive experience it was for Carol to work at IPB. There should be more places like it.”  Ed Orzechowski is a COFAR Board member and president of The Advocacy Network, an affiliated advocacy organization for people with developmental disabilities in Massachusetts.

A University of Massachusetts report noted that in 2010, there were 3,700 people with intellectual disabilities in sheltered workshops in Massachusetts and about 3,500 people in “integrated employment.” However, there were about 9,500 people in “non-work” settings, which appear to include DDS day programs.

COFAR has filed a Public Records Law request with DDS to try to determine how many people the Department anticipates will be transferred over the next five years to integrated workplaces, and how many will be transferred over that time to DDS day programs.

It’s unfortunate that sheltered workshops appear to be going the way of so many other previous high-quality programs and services for people with developmental disabilities in Massachusetts. The potential elimination of these services is usually vigorously opposed by families and guardians who understand how critically important they are.  But DDS has long perfected a wait-them-out strategy.

The Department understands that grassroots resistance to new, untried policies, can be worn down over time.

The politically incorrect idea of bringing congregate and community care together

January 7, 2014 5 comments

Two initiatives in two separate states call for something that would seem to make perfect sense — expand the missions of congregate care facilities for the developmentally disabled, and merge them with their surrounding communities.

In one case, the State of Delaware is proposing to expand services available at the Stockley Developmental Center by offering medical and dental care now available there to developmentally disabled and under-served persons living in the community.  A Delaware state task force has also called for considering an indoor community sports center or outdoor playing fields at the Stockley facility; and opening up a therapeutic horseback riding program and a therapeutic pool at Stockley to the surrounding community as well.

Like most of the developmental centers in Massachusetts, the Stockley Center sits on hundreds of acres of largely unused land, and currently serves only a small fraction of the hundreds of people who lived there four decades ago.

In the second initiative, the Arc of Jacksonville in Florida has been awarded state funding and tax credits to help construct a “planned neighborhood” in that state for adults with intellectual and developmental disabilities, according to The Florida Times Union.  The newspaper reported that the “Arc Village” will house about 120 adults – ages 18 and older – in 97 one- and two-bedroom apartments.  The $17.7 million project will allow residents to “live, work, shop, recreate, and socialize,” in one place.

Unfortunately, neither of these innovative initiatives would be likely to move forward in the “progressive” state of Massachusetts, and neither may get the backing of the Obama administration.  That’s because each of the proposals envisions providing services to a large number of people in one location — a non-starter to the ideological opponents of “congregate care.”

Congregate care, you see, is “institutional,” and therefore bad by definition for people with developmental disabilities.  It’s apparently better that they live in small group homes or apartments dispersed throughout the state. We happen to think that placing everyone in dispersed group homes or apartments is actually a recipe for isolation and a new form of warehousing of people with developmental disabilities, all the while lining the pockets of the executives of hundreds of state-funded, corporate providers.  (More about that in a coming post.)

But the Patrick administration in Massachusetts has voiced its opposition to  congregate care and has moved to close four out of six remaining developmental centers in this state.  Two of those centers have now been shut and most the residents have moved either to one of the two remaining centers or to group homes throughout the commonwealth.  Longstanding proposals by advocates of those developmental centers to more effectively merge them with their surrounding communities — similar to the Delaware proposal for the Stockley Center — were all rebuffed by the Patrick administration.

Meanwhile, the federal Centers for Medicare and Medicaid Services (CMS) are moving to change their definition of federally reimbursable community-based care to exclude even group homes that happen to be located on the grounds of, or even near to, a public institution such as a developmental center.  And the National Council on Disability has declared that an “institution” is a “facility of four or more people who did not choose to live together.”  The NCD’s definition, which applies even to many group homes, was contained in a report in 2012 that states in its first sentence that closure of all such “institutions” should be “a top public policy priority in every state where such institutions exist.”  The NCD advises the president and Congress on disability issues.

It’s hard to imagine the NCD supporting the Arc of Jacksonville’s proposal, in particular, which would establish a single setting, albeit a “neighborhood,” which would house 120 clients. And the Stockley Center proposal would not appear to conform to the CMS’s proposed definition of community-based care.

It seems to us, though, that the inclusive approaches being proposed in Delaware and Florida represent the future of care of the developmentally disabled in this country.  Both proposals appear to recognize that congregate care is a valid option for people who want and need it, and that it can coexist with, and even be a part of, community-based care.  Note that we’re not saying congregate care is right for everyone or that it should replace care in smaller settings.

The administration of Delaware Governor Jack Markell certainly appears to recognize that a congregate care center such as Stockley, which meets federal Intermediate Care Facility ICF/DD) standards, is worth maintaining as a residential option for its current residents.  The Delaware state task force report states among its “general principles” that its proposal for the Stockley Center would include “a commitment to maintain and build upon a peaceful environment that the people at Stockley Center currently enjoy.”

Rita Landgraf, secretary of the Delaware Department of Health and Social Services, was quoted in The Wilmington (DE) News Journal as saying: “We do have individuals who still live here on site. It is critically important that we bring inclusion to them. This was not a discussion of closing Stockley. Sometimes I hear that, out in the public. But we are not closing Stockley.”

Among the specific task force proposals for the Stockley Center that would establish the center as a critical component of community-based care in Delaware are the following:

  • Creation at the Stockley facility of a “Center for Excellence,” which would offer “integrated health support and disease prevention services to communities for which health services are hard to access.”
  • Creation of a facility at Stockley to support respite care, both for individuals with disabilities in the community system and caregivers.
  • Expanding the use of the Stockley pool or other therapeutic facilities for individuals with disabilities “first in Sussex County (DE) and beyond, as feasible.”
  • Creating an “intergenerational multi-use center for wellness that supports active living and wellness, including classes for smoking cessation, fitness, nutrition, behavioral health, obesity, cardiovascular disease and stress management.”
  • Developing fully accessible community vegetable gardens for an “integrated community” of county residents, including low income families; and hosting a farmers’ market.
  • Creating a “model of mixed-use development”on the Stockley campus site, including affordable housing, stores, restaurants, dental and medical, and recreational facilities.
  • Creating a training center to provide professional development for medical and care providers.
  • Encouraging schools to use the Stockley property for nature and science instruction.
  • Providing education, support, life skills and vocational or job training programs for people with disabilities.
  • Creating a center for volunteer and nonprofit groups.
  • Creating an outdoor trail system for users of all ages and abilities.

Contrast the excitement and vision of that approach with Massachusetts where we’ve seen only the systematic dismantling of congregate care for people with developmental disabilities.  We will soon be down to two remaining ICF-level care centers, and what remains of state-operated care is under siege as facilities and services continue to be privatized.  It’s refreshing to know that not all state administrations have that mindset, and that in some places, new ideas are being tried by people who are not blinded by outdated ideologies.  We, however, are being left in their dust.

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