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Fatal assault at Templeton Center raises questions about admissions and staffing
The death last month of an intellectually disabled man, who was allegedly assaulted at the Templeton Developmental Center by a resident there, appears to raise questions about the dangerousness of the people being admitted to the facility and the adequacy of the staffing and supervision there.
Dennis Perry, 64, was allegedly assaulted on September 16 by Anthony Remillard, 22, while the two men were working at the Templeton facility’s dairy barn. At the time, Perry was a resident of a group home and was working in the barn on a daily basis.
The Worcester Telegram & Gazette reported that Perry had allegedly been shoved by Remillard into a boiler in the barn and suffered a serious head injury. The incident occurred in front of two staff members whose statements indicated the attack was unprovoked, according to the newspaper, which was quoting from a State Police report of the incident. Perry died on September 27 at UMass Memorial Medical Center.
Prior to his admission to Templeton, Remillard had been charged in a May 6, 2012 arson in a vacant building in Worcester, according to the newspaper. At his arraignment on that charge, prosecutors recommended that Remillard be evaluated at either Bridgewater State or Worcester State Hospital. But the recommendation was rejected by the judge, and Remillard was allowed to enter a “pre-trial release commitment” at Templeton.
The Templeton Center, located in Baldwinville in central Massachusetts, has been marked for closure since 2008. The facility is scheduled to be converted into state-operated group homes from its current status as an Intermediate Care Facility for the developmentally disabled (ICF/DD).
Paula Perry, Dennis Perry’s sister, said she and other family members were told by the Worcester County District Attorney’s Office that Remilard’s attorney didn’t feel that either Bridgewater State or Worcester State Hospital would be a safe environment for his client, and Remillard “was okayed to go to Templeton.” She said her family was unaware that there were any residents with criminal backgrounds or criminal charges at Templeton. They only found out about Remillard’s previous arrest on the arson charge after reading about it in the newspaper.
Paula Perry added that she understands that Templeton had the option of refusing to accept Remillard. “Why they would accept someone like that I don’t know,” she said.
While Templeton has historically accepted individuals with criminal backgrounds as residents, those persons have in the past been carefully evaluated as to their level of dangerousness prior to admission, according to Bonnie Valade, a COFAR Board member and the mother of a Templeton resident.
At this point, we don’t know if Remillard has an intellectual disability or not. If he does have ID, it might have been appropriate to have considered him for admission to Templeton. However, Dennis Perry’ death does appear to raise questions about whether Remillard should have been there and whether the staff supervision of him was adequate. Here was someone who had an allegedly violent criminal past and who was allegedly capable of unprovoked violence. To us, the two linked questions here are: Why was Remillard admitted to Templeton over the objection of the DA, and why was he allegedly able, once there, to attack and fatally injure someone?
We sent an email request on Monday to DDS Commissioner Elin Howe, seeking the Department’s policies and procedures regarding both admission to Templeton, and staff supervision of residents who have either behavioral problems or criminal convictions or charges on their records. We want to know specifically whether persons who are not intellectually disabled are ever sent to Templeton, and whether any of the Department’s policies regarding admissions and staffing have changed since Templeton was slated for closure in 2008.
Since 2008, the Patrick administration has significantly phased down operations at two ICFs/DD — Templeton and the Fernald Developmental Centers, and closed two others — the Glavin Regional Center and the Monson Developmental Center. ICFs/DD are required to meet strict federal standards for treatment and staffing that do not apply to group homes and other community-based residential settings in Massachusetts and other states.
Since 2008, Templeton’s residential population has been reduced from 123 to 42. Valade maintains that as the population there has gone down, both staffing and services at the center have been steadily reduced as well. Here is what Valade had to say about Templeton in an email in the wake of Dennis Perry’s death. The situation she describes may have a bearing on the case:
Shortly after the (Templeton) closure was announced, the staff that had been there started to leave. I was reminded that none were let go. Well, no one had to be told to leave…if you are told your place of employment is closing you look elsewhere for work. So they lost the best staff. These staff members had been there for years, which made them the best qualified staff I have ever known, and the clients felt like they were family.
… I am in fear for my son…with his issues he could have been the Dennis (Perry) or the Anthony (Remillard). For years I have felt my son was in a safe environment, and now here I am worried sick about his care.
No one with a family member in the DDS system should be worried sick about their care. The Department can help by providing answers as soon as possible to the questions we’ve asked about their admissions and staffing policies at Templeton. And we hope the Department cooperates fully with the Perry family, in particular, in providing the answers they are seeking in this case.
The story of a remarkable woman
I never met Joanna Bezubka, who lived at the Fernald Developmental Center for 39 years and then spent the final seven years of her life in a state-operated group home in Lynnfield.
But after reading “Joanna, God’s Special Child,” a new memoir by George Mavridis, I feel I got to know her well enough that I’m sad I never will meet her in the flesh. That’s because Mavridis, Joanna’s cousin and co-guardian, has written an account of her life that makes you realize what a truly remarkable person she was — filled with charm and humor and an independent spirit.
These are qualities that many of us would not think possible in a person with a profound intellectual disability whose vocabulary was limited to about 50 words and a small range of vocal inflections. Joanna, who had Down syndrome and the cognitive ability of a two-year-old child, died in January 2012 at the age of 60 after developing Alzheimer’s disease.
Given its title, some people might think this book comes at its subject from a religious or sentimental perspective. It is neither of those. As Mavridis explains, “God’s special children” was a description given in the 1950’s by Richard Cardinal Cushing, Roman Catholic Archbishop of Boston, to individuals with mental retardation, now known as intellectual or developmental disability.
It’s not that Mavridis rejects Cardinal Cushing’s description. Mavridis is in fact a practicing Catholic who pushed hard to allow Joanna to continue attending Mass every Sunday at the Chapel of the Holy Innocents at Fernald, long after she had left the facility as a resident. It’s that Mavridis goes so much further than Cardinal Cushing’s description in telling us who Joanna really was.
George Mavridis and Joanna Bezubka celebrate her 59th birthday
Mavridis, a former president of COFAR and The Fernald League, has chronicled Joanna’s life down to some of the smallest details in a matter-of-fact, journalistic style that is all the more compelling because it deals honestly with the major issues of her life, even some of the most difficult and painful episodes. Those episodes include a sexual assault of Joanna, allegedly by staff in a group home in which she lived, and Mavridis’s dogged pursuit of the investigation of the incident.
It’s important to note that Mavridis is a strong defender of a comprehensive system of care for people with developmental disabilities, including the availability of federally regulated Intermediate Care Facilities (ICFs) for those, like Joanna, who need or needed them. Mavridis has been a central figure in the still-ongoing effort to keep Fernald open. He is also a member of the legislative committee of the VOR, a national advocacy organization for the developmentally disabled, which, like COFAR, supports ICF-level care. As a VOR legislative committee member, Mavridis organizes visits with the health aides of the members of the New England congressional delegation.
But the purpose of Mavridis’s book is not to make a statement on one side or the other in the debate over institutional versus community care. It is rather to chronicle a person’s life and to demonstrate the necessity and effectiveness of advocacy for the most vulnerable among us.
If you are the guardian or family member of a developmentally disabled person and you are looking for help in how to cope and advocate on their behalf, I think this book will be very helpful. I think it would also be helpful to legislators and others who seek a better understanding both of who developmentally disabled people are and what is involved in caring and advocating for them.
If nothing else, this book provides a detailed set of reasons for the importance of a provision in federal law, which states that family members should be seen as the “primary decision-makers” in caring for intellectually disabled persons. As Joanna’s co-guardian and the family member most intimately involved in her life, Mavridis was an a far better position to understand her needs and to act in her best interest than the bureaucrats and even some other advocates who often claimed to know what was best for her.
There is one small but telling incident in the book that illustrates that point particularly well. Joanna was a diminutive woman — only four-foot, four inches tall — and Mavridis bought all her clothes for her. He recounts that he would occasionally hear disapproving comments from Department of Developmental Services staff members that the Disney characters on the sneakers he had bought for her were not appropriate for a woman her age. “I would respond,” he writes, “that they should go to a shoe store and look for a woman’s size 2 1/2 pump with a low heel and buy them for Joanna.”
Joanna’s mother died during a heart operation in 1966 when Joanna was 15 years old. As a result, Mavridis’s mother, Stella, became her guardian, and Mavridis himself became co-guardian in 1991. In later years, Joanna’s brother Ronald Bezubka became a co-guardian along with Mavridis; but as Ronald was living in England, Mavridis remained in charge. In Joanna’s later years, Mavridis would visit her twice a week at her group home and take her to his home in Peabody every Saturday.
Throughout, Joanna’s story is told with warmth and humor, largely because of Mavridis’s clear and obvious love for his cousin. He writes that his mother “always said that I was the brother that a girl feels she could hold under her thumb, and Joanna never let me up.”
We learn, for instance, that although Joanna’s teeth had been removed and her food had to be ground, she was a “gourmet,” who “ate very slowly and savored every morsel.” At Fernald, the staff “served her first and picked up her dishes last, so she had time to enjoy her meals.” She also liked to sip coffee all day long and always had a cup with her, which she invariably perched on the edge of the table. “Many times my mother would move it back, away from the edge,” Mavridis writes, “but Joanna wold move it back with a stern look.”
One of Joanna’s favorite games with people was to ask them to cuff her shirt sleeves. “After you did it, Joanna would straighten the sleeves and ask you to cuff them again. This exercise became endless.” Her favorite activities also included playing with Lego toys and tearing paper into ever smaller pieces. Mavridis found he was obliged to carry a supply of both Lego pieces and pieces of paper with him because Joanna liked to hand out both as tokens of friendship to anyone who came by her.
Playing the shirt-sleeve cuffing game
Mavridis also speaks frankly about his own quadruple coronary artery bypass operation, which happened in the same year as the sexual assault, and the effect of his temporary incapacitation on Joanna. He also details Joanna’s physical and mental decline beginning in 2008, when she developed Alzheimer’s Disease, a condition which afflicts nearly all people with Down syndrome as they age.
Mavridis relates how sad it was for him to watch Joanna’s limited ability to communicate disappear in her final four years. She stopped tearing paper and she stopped playing with Legos and handing them out as tokens. Mavridis nevertheless was determined to make her life as comfortable as possible and bought special lift equipment for her as well as a special hospital bed and recliner.
“I bet I blinked first,” Mavridis says of this photo.
Near the start of his book, Mavridis includes a short article by a writer, Emily Perl Kingsley, about what parents go through when they first learn that their child is intellectually disabled. “When you’re going to have a baby, it’s like planning a fabulous vacation trip to Italy,” Kingsley writes. Instead, the plane lands in Holland.
“The important thing is that they haven’t taken you to a horrible place,” Kingsley continues. “It’s just a different place, so you must go out and buy new guide books and you must learn a whole new language…but after you’ve been there for a while…you begin to notice that Holland has windmills; Holland has tulips; Holland even has Rembrandts.”
“Joanna, God’s Special Child” is the story of a wonderful journey to Holland for Mavridis and his family, and of their discovery of the windmills, tulips, and Rembrandts there.
Massachusetts lags in criminal background checks for caregivers to disabled
While the Patrick administration appears to support national criminal background checks for people hired to care for the intellectually disabled, the administration has failed to apply for federal grant funding that would help it design a federal background check program.
The administration also does not seem to have aggressively pursued proposed legislation in Massachusetts that would authorize national background checks of people hired to work in the Department of Developmental Services system.
This is an administration that has been nothing short of enthusiastic about closing state-run care facilities and moving the residents in them to community-based group homes. But as far as protecting those people from abuse and neglect in the community system is concerned, the administration’s level of enthusiasm seems to drop off sharply.
National background checks involve matching a job applicant’s fingerprints against a federal database maintained by the FBI. This table I compiled shows how each state compared as of 2008 regarding national background check requirements, and which states have taken advantage of federal grant funds available since 2010 to design a national background check program.
As the table shows, Massachusetts was one of 16 states as of 2008 that had no national background check requirements. (The information is based on a survey by the National Conference of State Legislatures.) It is still the case today that Massachusetts requires only in-state criminal background checks of people hired to work in the DDS system.
As the table also shows, Massachusetts is among as many as 27 states that haven’t applied for the grants that have been available from the Centers for Medicare and Medicaid Services under the Affordable Care Act “to design comprehensive national background check programs for direct patient access employees.” A total of 23 states and Puerto Rico have been awarded a total of $53.4 million in those grants, which have been as high as $3 million per state.
Every advocacy group for the disabled that I know of agrees that state-only background checks are not sufficient in screening applicants seeking jobs in caring for the disabled because those checks turn up only convictions for criminal activity in that state. The checks do not identify criminal convictions that a job applicant might have from another state.
In testimony to the state Legislature’s Judiciary Committee last month, State Representative Martin Walsh stated that the state Disabled Persons Protection Commission had identified 1,000 cases in which “criminal abusers” were working in Massachusetts, and that one out of five of them had come from outside the state.
I contacted the Massachusetts Executive Office of Health and Human Services and the Department of Developmental Services regarding the federal grant program, and received a response from Victor Hernandez, a deputy assistant DDS commissioner. Hernandez stated in an email that the state has not applied for a CMS grant because Rep. Walsh’s legislation authorizing national background checks by DDS is not yet in place. Once such legislation is enacted, Hernandez wrote, “we will pursue the federal dollars.”
That sounds reasonable enough except that under the grant rules, the state is not obliged to wait for enactment of a national background check statute before receiving the funding. In an online FAQ about the grant program, the CMS states that in cases in which “necessary state legislation is not in place prior to the start of the grant period,” CMS would “work with the state to identify a portion of the potential grant funds that would be available immediately and additional funds that may be available at a later time when the additional authority is in place.”
I also received an email from CMS, which stated that there are a number of states “that have been in the (national background check grant) program for several years and have yet to be successful in implementing state laws.”
I wrote back to Hernandez to ask if the Patrick administration has worked with CMS to identify a portion of the grant funds that might be immediately available to the state. I haven’t yet heard back.
It’s not only the administration that can’t seem to get excited about protecting the developmentally disabled from abuse and neglect. The Legislature as a whole doesn’t seem to have an attitude that is much different in that regard.
As I’ve previously noted, Walsh’s proposed national background check legislation for new workers in the DDS system has been stalled for a number of years in the Legislature. Last year, the Legislature did pass a bill to implement a national background check requirement for people hired to work in public and private school systems in the state. Massachusetts, however, was reportedly the last state in the nation to enact a national background check for school personnel.
This year’s national background check bill for DDS system workers (H. 1674) was filed by Walsh in January and referred to the Judiciary Committee at that time. The committee only got around to holding a public hearing on it on July 9, and still has not acted to approve the measure.
Walsh noted in his testimony to the Judiciary Committee that his bill had been approved twice in the past two years by that committee only to be sent to the House Ways and Means Committee to die a slow death.
That the developmentally disabled are subject to abuse and neglect in the community system of care is hardly disputed by anyone who looks at the matter objectively. The VOR has cited an “alarming number” of deaths and cases of abuse of developmentally disabled individuals around the country, and noted the “prevalence of preventable deaths at privately run group homes across this nation.” Community-based care, which is primarily delivered in widely dispersed group homes, is by definition harder to monitor and oversee than care delivered in larger congregate-care settings.
But whether abuse, neglect, or misappropriation of funds occurs in the privatized or state-run systems of care, the federal CMS has recognized those three issues as “a widespread problem for millions of Americans receiving LTC (long-term care) services.”
Let’s hope that both the Patrick administration and the state Legislature begin soon to place a higher priority on finding a solution to those problems. The administration could show it is placing a priority on addressing abuse and neglect, at least, by applying immediately for a CMS grant to design a workable national background check program in Massachusetts; and the Legislature could begin by acting as quickly as possible to pass Rep. Walsh’s national background check bill.
Making care for the disabled a zero-sum game
There is no question that Massachusetts is facing budget problems that are making it increasingly difficult to fund services for our most vulnerable citizens, particularly those with intellectual and other disabilities.
One thing we shouldn’t do in this situation, though, is try to help one group at the expense of another. That, in our view, is what two pieces of proposed legislation now before the Children, Families, and Persons with Disabilities Committee would do.
Both bills were the subject of a public hearing last week before the committee. I wanted to testify about both of them, but they were way down on the committee’s hearing list. After waiting two and a half hours to testify and then realizing by that time that almost all of the legislators on the committee had left, I left the hearing without testifying publicly and submitted my remarks in writing to the committee staff the next day.
I’ve already written several times about one of these two bills – the ‘Real Lives’ bill (H. 151), though not specifically about how it would potentially divert funding from intellectually disabled people living in state-operated group homes to corporate providers that contract with the Department of Developmental Services. I’ll get to that in a bit.
Early on in last week’s hearing, I first found out about the other bill, which was filed by state Representative Tom Stanley at the behest of the Association of Developmental Disabilities Providers (ADDP), the lobbying organization for those same state-funded, corporate providers.
Stanley personally appeared before the Children and Families Committee to promote the ADDP bill (H. 156), which would require that at least half of the “savings” in closing state-run DDS developmental centers be used to fund programs run by corporate providers. (Legislators don’t have to wait to testify at committee hearings, but are given the floor when they show up.)
Specifically, Stanley’s bill would require that “not less than 50 percent” of those developmental center closure “savings” be used to “fund and implement Chapter 257 of the Acts of 2008.”
What is Chapter 257 of the Acts of 2008? As the ADDP notes, it is a statute that provides for “standardization and adjustment for rates to contracted human and social service providers.” In other words, it’s intended to adjust state payments to the group home providers upwards. Last January, the ADDP was anticipating that the administration would provide up to $175 million in funding in the current-year budget to implement Chapter 257.
As the ADDP put it on their website:
After waiting for nearly 25 years, developmental disability programs (read “the providers”) may finally see their prayers answered with Governor Deval Patrick’s FY 14 House One Budget….
An administration document posted by the Providers’ Council, another provider lobbying group, last January indicated that the governor had proposed that at least $53 million in Chapter 257 funding go directly to the provider residential line item in the DDS budget in the current fiscal year.
The ADDP’s and the Providers’ Council’s prayers, however, were apparently not fully answered. The total proposed Chapter 257 funding apparently did not materialize in the final budget for the current fiscal year. The provider residential line item in the final budget, as approved by the Legislature, is $13.1 million less than what the governor proposed in January.
In a July 2 recap of the final FY 14 budget, the Arc of Massachusetts, a close ally of the ADDP and the Providers’ Council, stated that the organization was hoping for passage of a supplemental budget this year “to fully implement Chapter 257 in Residential Services for 2014.”
But what if such a supplemental budget is not forthcoming? Maybe that explains the need for Rep. Stanley’s bill. Because the Legislature was apparently not willing to put the amount of additional money into the provider group home line item that the ADDP, the Providers’ Council, and the Arc were seeking, the ADDP figured they could get it from somewhere else. That somewhere else is apparently the developmental center closure “savings.”
While we would dispute that there has actually been any savings in closing the developmental centers, what has occurred is that the developmental center line item in the DDS budget has been cut by some $80 million since FY ’09, when the administration first announced it planned to close four of the centers.
It seems the funding cut from the developmental center line item has gone in the past five years to the state’s General Fund, rather than being plowed back into the provider-run, community-based system, as the administration had originally promised. However, at least some of that money has been transferred back from the General Fund to both the state-operated and provider-run group home accounts.
As the developmental centers have been closed, a large percentage of the former residents has been moved primarily to one of two remaining developmental centers and to state-operated group homes. The state-operated group home line item has thus been increased by about $41 million since FY ’09, largely to accommodate that influx of residents. The provider-run group home line item has been increased by some $230 million in that time.
So, now we have Rep. Stanley’s bill, which says, as we understand it, that at least 50 percent of the funds cut from the developmental centers must be directed to fund Chapter 257. Given that passage of this bill would result in a significant increase in funding for the providers (or else why would the ADDP want this bill filed?), what does that mean for the state-operated group homes? There is only a finite pot of money involved. Funding for the state-operated group homes would potentially have to be cut.
We know that the state-operated residential facilities are struggling in Massachusetts. These facilities are required under court order to provide care for most former developmental center residents that is equal or better to the care they previously received. Although funding has been increased to the state-operated group homes, the increase this year was significantly less than what the administration projected was needed.
These are among the questions I posed in a phone call on Thursday to Rep. Stanley. In filing his bill on behalf of the ADDP, did he understand the full implications for the state-operated group homes, in particular, and the level of services the residents in them would continue to receive?
Stanley responded that he believed his bill would “help both the state-operated and provider-operated group homes.” He said it was his understanding that Chapter 257 would boost funding to most, if not all, DDS line items and that he would get back to me to confirm that. I’m waiting for his follow-up call.
As I noted to Stanley in an email following our Thursday phone call, there are many documents online about Chapter 257, and they indicate, as I’ve noted above, that Chapter 257 was intended and drafted to fund purchase-of-service programs only, not state-operated programs.
For example, there is that administration document posted by the Providers’ Council, linked above, which shows the proposed $53 million in Chapter 257 funding going into the provider residential line item in the DDS budget. While some of the Chapter 257 funding would go to other agencies in the Executive Office of Health and Human Services, nothing in the document indicates that any of the Chapter 257 funding would go toward the DDS state-operated group homes. Chapter 257 is clearly targeted toward contracted services obtained from corporate providers to DDS and other EOHHS agencies.
So, how much money are we talking about in diverting 50 percent of the funding cut from the developmental centers to the providers? In the current fiscal year, it appears the developmental center line item has been cut by $10.8 million from the previous fiscal year. Fifty percent of that figure would be $5.4 million.
As noted above, the final FY 14 budget provided $13.1 million less in funding for the provider residential line item than did the governor’s budget proposal. Thus, if Rep. Stanley’s bill is passed, it would seem the providers would get back some $5.4 million – or about 41 percent – of the amount the Legislature had cut from the governor’s proposal in the current fiscal year. Not the whole ball of wax, but it would reduce the amount that would be needed in that hoped-for supplemental budget to satisfy the providers.
It turns out, though, that Rep. Stanley’s bill was not the only piece of legislation heard by the Children and Families Committee last week that would divert funding from the developmental centers to the providers. There’s also the Real Lives bill, proposed by Rep. Tom Sannicandro. While I was there, a long line of legislators testified in favor of that measure, which is intended to give all DDS clients more choice in services. The Real Lives bill happens to state that 40 percent of the “savings” in closing at least three of the developmental centers must be directed to a fund that would support “self-directed services,” presumably for all DDS clients.
As I’ve previously pointed out, the Real Lives bill specifies a large role for the providers in establishing that self-directed services fund. And one of the purposes of the fund would be to subsidize providers who lose funding when their clients leave their facilities for facilities run by other providers.
So, between these two bills (proposed by Reps. Sannicandro and Stanley), it would seem that at least 90 percent of the funding cut from the developmental centers would be earmarked for specific funds or line items that would help the providers, in potential competition with the state-operated group homes and other DDS accounts. Ninety percent of the $10.8 million cut from the developmental center line item in the current fiscal year totals roughly $9.7 million. Now, we’re talking about the providers getting back $9.7 million – or almost three quarters – of the amount the Legislature had cut from the governor’s proposed funding for provider-run group homes.
To be clear, we support adequate funding of provider-run group homes and thus we support full funding of Chapter 257. But we don’t support that funding increase coming at the expense of the state-operated group homes or other DDS line items. Robbing Peter to pay Paul should not be the solution to the problems the administration is facing in providing care to everyone who needs it.
‘Real Lives’ bill proponents are abandoning the democratic process
It appears the supporters of the flawed ‘Real Lives’ bill are trying an end-run around the normal democratic process for getting bills enacted in the state Legislature.
Their latest strategy has been to insert the language of the proposed legislation into the state budget bill for the coming fiscal year via an amendment process that does not require any recorded votes or public hearings. The fate of the proposed legislation therefore will now be decided as part of the closed-door horse-trading that is going on among the six members of a House-Senate conference committee on the budget.
I’ve written before about our concerns with the Real Lives bill, which is intended to give clients of the Department of Developmental Services more choice in the services they receive. While we support the overall concept of the bill, our concerns about it center around provisions that we believe are primarily intended to benefit corporate providers to DDS. As we see it, one of those provisions will essentially compensate providers for not providing services.
The prime sponsor of the bill, Representative Tom Sannicandro, has tried without success in recent years to get the bill enacted through the normal legislative process. That process of course involves first referring the measure to the appropriate legislative committee (or committees).
The appropriate committee — in this case, the Children, Families, and Persons with Disabilities Committee — would then schedule the bill for a public hearing and vote the measure up or down. If approved by the committee, the measure would ultimately be voted up or down by the full membership of the House and Senate, whose votes on the measure would be recorded.
Last year, the Real Lives bill was passed by the House, but the Senate declined to take it up, so it died at the end of that session as a result. We first expressed our concerns about the provider-friendly provisions of the bill to Sannicandro during the debate on it last year.
Unfortunately, when Sannicandro re-introduced the bill (now H. 151) at the start of the current legislative session in January, he made no changes to it, despite our concerns. The corporate-friendly provisions were all still there.
The bill was duly referred on January 22 to the Children and Families Committee. To date, the committee has not scheduled the bill for a public hearing. I called the committee this week to ask why no public hearing had yet been scheduled and was told it was because Sannicandro had asked that a hearing on the bill not be scheduled because the language in the bill was being proposed as a budget amendment.
Sannicandro’s budget amendment was in fact adopted by the House during its budget deliberations in April, meaning the House leadership agreed to put the amendment in the “yes pile” of amendments approved as a bloc by an unrecorded voice vote on the House floor. However, an identical amendment was subsequently placed by Senate leaders in the “no pile,” meaning it got rejected in that chamber by a similar unrecorded voice vote. As a result, it’s now up to the conference committee to decide whether the Real Lives bill lives or dies.
We don’t think the “yes pile” and “no pile” process used in the House and the Senate for deciding budget amendments is a particularly good or democratic one. We understand the rationale for it is that it saves a lot of time taken up by debate on budgetary issues — something we understand used to occur in the distant past in the Massachusetts Legislature.
But while there may be a valid rationale for taking up budget-related amendments in blocs that are not subject to debate or recorded votes, we don’t think that rationale applies to something like the Real Lives bill. The Real Lives bill is intended to make far-reaching changes in the way services are delivered to people with developmental disabilities. It appears to be only marginally a budgetary measure, and that’s only because of the special fund it sets up to compensate providers for not providing services.
For that reason, we wrote to Sannicandro yesterday, urging him to prevail on the conference committee not to adopt his bill, but to let the measure take the normal, democratic course in the Children and Families Committee. We think that’s the right way to go on this important issue.
Thousands falling through the cracks in the DDS system
Lauren Baletsa has Prader-Willi Syndrome, a genetic defect that causes such a strong compulsion to overeat that she forged her father’s signature on checks to buy food.
Baletsa was one of dozens of people who testified on Tuesday before the Legislature’s Children, Families, and Persons with Disabilities Committee in support of proposed legislation that would require the state to provide services to people with Prader-Willi and other developmental disabilities.
Many people with these disabilities have cognitive impairments and autism, leaving them unable to function normally or adequately in society. However, many of them have IQs that are just above the cutoff level to qualify for services from the Department of Developmental Services.
In testimony before the Committee, Rick Glassman of the Disability Law Center maintained that Massachusetts appears to be the only state in the nation that does not grant eligibility for services unless the individual has an intellectual disability as measured by an IQ score.
Glassman said research done by the DLC indicates that every other state provides services based on at least some additional measures of disability such as substantial functional limitations or designated impairments such as autism. “I hope I’m wrong about that and am missing something,” Glassman said. “But if so, I can’t figure out what it is.”
Glassman and other advocates, including COFAR, noted that DDS’s restrictive eligibility standard for services has left thousands of people in the state without services of any kind. COFAR has joined the DLC, the Arc of Massachusetts, the Aspergers Association of New England and other organizations in urging support for legislation (H.B. 78 and similar measures) that would require DDS to provide services to people with developmental disabilities and not just “intellectual disabilities.”
As Glassman and others pointed out, just because someone has an IQ higher than 70 (the DDS’s approximate cutoff level for providing services) does not mean that person is high functioning or able to complete even basic tasks such as dressing or bathing without assistance.
Awilda Torres is a case in point. She testified Tuesday that her son Carlos, 22, who has autism, was recently riding in a van when he jumped out while the van was moving, ran to a policeman and insisted he had been kidnapped by the driver. Carlos’s IQ, Torres said, is just above the DDS cutoff point for services.
Other parents of autistic adults testified that while services and even state-supported day and work programs were available to their children before they turned 22, those programs ceased once the children reached that age. At the age of 22, people with intellectual disabilities in Massachusetts, who had been receiving special education services through local school districts, must enter the DDS system with its more restrictive eligibility standard.
Karen Kadzen-Pandolfi testified that her son, who is now 23, lost his services a year before because his IQ was measured at 71. He has a problem with aggression and violent behavior. As a result, she must now stay home from her job to care for him. “My life is on hold,” Kadzen-Pandolfi said. “I keep searching for an answer, but there are no answers.”
Delivering COFAR’s testimony, I noted that the public is largely unaware of the severity of these developmental disabilities and of the fact that so many people are not receiving any services to cope with them. Tuesday’s hearing at the State House was not covered by any mainstream media outlets nor was a similar hearing last November in Worcester that had been held by DDS to consider proposed regulations regarding its IQ eligibility standard.
State audit confirms salary overpayments to DDS provider
The state improperly reimbursed the May Institute, a corporate provider to the Department of Developmental Services, for hundreds of thousands of dollars paid to company executives in excess of a regulatory cap on their salaries, according to the state auditor.
The auditor’s findings confirm concerns we raised in April and May 2011 that the state may have paid Walter Christian, the CEO, and other executives of the May Institute more than the state’s approximately $143,000 regulatory limit on individual executive salaries.
The auditor also found that Christian was improperly paid roughly $140,000 for a home health aide for his wife, day care fees for a grandson, the use of a minivan in Georgia, and a separate vehicle that he used when visiting Massachusetts. Christian, who retired in January, had been living in Georgia for a decade while running the Massachusetts-based company, according to the audit report.
Our blog posts in 2011 specifically noted that the May Institute appeared to be under-reporting Christian’s and other executive salaries as well as the number of people receiving those salaries, on Uniform Financial Reports (UFRs) submitted to the state Operational Services Division.
The two posts also noted that the same under-reporting of salaries appeared to be the case with Vinfen and Seven Hills, two other DDS providers. The state auditor focused solely on the May Institute, however.
The state auditor’s report noted that a state regulation capped state reimbursements to providers for salaries and other compensation paid to their executives at $143,986 in FY 2010 and $149,025 in FY 2011. Providers can pay their executives more than those amounts in salaries and other compensation, but the state is permitted to reimburse the providers only up to the threshold amount in a given year. The state attempts to keep track of those payments via the UFR’s, which the providers are required to submit to the Operational Services Division on a yearly basis.
We noted in our April 2011 post that the May Institute’s UFR listed only Christian and one other executive as making over the state salary threshold in 2009. Yet, a federal tax form, which was filed by the May Institute with the IRS for the same fiscal year, listed 13 individuals in the company as making over $150,000 each.
An OSD official maintained at the time that the state agency allows the state to pay costs in excess of the salary limit for clinicians working for providers. However, COFAR’s May 2011 post noted that all 13 May Institute employees who made over $150,000 were not listed on the IRS form as clinicians, but as executive-level employees, starting at senior vice presidents on up to the president and CEO.
In its report, the state auditor also found that several May Institute employees who were paid over the threshold amounts were managers and not clinicians.
We think this report by the state auditor lends strong support to our call for a comprehensive, independent study of outsourcing of care by DDS. The auditor’s findings also support the need for more funding for state-operated group homes for the developmentally disabled as an alternative to provider-operated residences.
But as I noted in a previous post, House leaders last month rejected budget amendments that would have both authorized a study of the DDS system and restored cuts made by the House Ways & Means Committee in the governor’s budget for state-operated residences. There is one more chance for these amendments coming up in the Senate, of course.
We applaud the state auditor for examining the May Institute’s payments to its executives. We hope, though, that Auditor Suzanne Bump expands her review to include additional providers in the wake of our concern that this is a potentially wider problem than just one company.
The House lets down the most vulnerable
Have our legislators forgotten about the most vulnerable people in our society?
Unfortunately, that’s the message we’ve taken away from last week’s actions by the House on the state budget.
First, we urged legislators to approve an amendment calling for a comprehensive, independent study of the Department of Developmental Services system, along the lines of a similar study that was approved last year of the Department of Mental Health system.
Among the questions we think need to be examined are whether the ongoing privatization of services to people with developmental disabilities is really resulting in improved care. Or is this trend simply padding the ample salaries of the executives of the hundreds of corporate providers that contract with DDS?
We also urged legislators to approve additional funding to prevent the layoffs of state service coordinators, who make sure that people in the DDS system are getting the services they need. And we asked for additional funding to prevent the possible closures of state-operated group homes, to which many former residents of state developmental centers are being sent as those centers are closed down.
The House rejected all of those amendments. But they did pass an amendment that provides all kinds of goodies to the corporate providers, including a state subsidy if residents of their group homes opt to leave those homes. That amendment will implement the so-called ‘Real Lives’ bill, without bothering with the need for a public hearing.
Could all this have anything to do with the fact that legislators nowdays seem to act solely in the interest of those who contribute the most to their political campaigns? Is there anyone out there who still doesn’t believe that’s the way our modern “representative” system of government works?
Apparently, lawmakers don’t feel under much of an obligation anymore even to fulfill promises made to those who don’t have political clout on Beacon Hill, or Capitol Hill for that matter.
What else are we to make of the virtual promise that state Representative Patricia Haddad, a leader in the House, who spearheaded last year’s legislation to study DMH, made to support the DDS study?
In a meeting with families of residents of the state-run Glavin Regional Center in September, Haddad had this to say about the proposed DDS study, which would have included a study of the closure of Glavin itself:
“Someone has to be the first to say we’re not afraid to have an outside study done to tell us what’s wrong and what’s right,” she said. That day, she also said a number of other things that the Glavin families desperately wanted to hear from her, including the statement that “there are more horror stories than good stories” in the privatized system of DDS care.
It initially came as a shock to us, therefore, when we found out just before the budget debate last week that Haddad had declined even to co-sponsor the amendment to undertake that outside study of DDS. Maybe she truly feels that someone has to be the first to say we’re not afraid to have the study, but it wasn’t going to be her.
Why won’t legislators like Haddad support these critically important initiatives for our most vulnerable residents when push comes to shove? Is there anyone who doubts that we need to re-examine the DDS system? It is a system in which, as Haddad herself said, there are often more horror stories than good stories.
As the state has increasingly come to rely on corporate-controlled care for people with developmental disabilities, the waiting list for services only appears to be growing longer. It’s a system in which the state does a mediocre job at best in monitoring the care provided in thousands of dispersed residences whose staff are largely poorly paid and do not receive adequate training.
It’s a system that is beginning to resemble the “warehouses” of yesteryear, when thousands of people with developmental disabilities were packed into institutions that did not have the staff or resources to care for them. Now, they’re simply packed into corporate-run group homes, which don’t have the staff or resources to care for them.
When will our elected leaders wake up to this and care enough to do something about it?
Autism Commission report has important recommendations, but funding remains a question
A state report released last week contains a number of important recommendations to begin to deal with the yawning gap in services, job opportunities, and housing for what may be the fastest growing group of developmentally disabled people in the state and the country.
The Governor’s Commission on Autism listed 13 priorities in addressing the problem, including expanding the number of people eligible for care from the Department of Developmental Services, expanding available community-based services, and expanding private insurance coverage available to families of autistic children and adults.
One apparent shortcoming of the report — and we’re not saying it would be easy to address that shortcoming — is that the report doesn’t say where the money would come from for all of these necessary expansions. It doesn’t appear that even Governor Patrick’s proposed tax increases to fund his Fiscal Year 2014 budget would come close to providing the needed funding for what the Commission notes needs to be done.
It’s somewhat ironic that even as the governor’s Commission calls for these service expansions, his proposed budget would cut funding to the state Autism Division, which manages a key children’s program that the Commission has proposed expanding.
The Massachusetts Budget and Policy Center’s budget browser shows an inflation-adjusted cut in the governor’s FY ’14 budget proposal of 2.6 percent from the amount appropriated for the current fiscal year for the Autism Division.
It’s also ironic, looking back on it, that then Secretary of Health and Human Services JudyAnn Bigby told The Boston Globe in 2008 that the planned closures of four state developmental centers for the intellectually disabled would free up some $45 million a year for community-based programs, including services for people with autism.
Since that time, close to $70 million in inflation-adjusted dollars has been cut from the developmental centers line item in the budget. But that money does not appear to have been used to boost most community-based line items. Funding for the Autism Division has, in fact, declined by about 5 percent since Fiscal Year 2009. (Again, these numbers are based on the MBPC’s budget browser.)
Nevertheless, we applaud the Commission for calling further attention to the current lack of adequate services for children and adults with autism, and for its endorsement of proposed legislation in the current session to expand DDS’s responsibility to care for people with autism who don’t currently fit within the Department’s eligibility guidelines (H. 78 and S. 908).
The report criticized inadequate staffing levels in community-based residential care for people with autism and low compensation of staff, which has led to high turnover. The report also noted that many adults with autism live with elderly parents and have “few options for future housing and support.” In addition, the report cited “an unknown backlog of people who would apply for aid if relevant programs existed.”
And the report called for hiring “highly trained service coordinators specially trained in autism.” The report didn’t discuss how this would be done, given that the state has been steadily eliminating service coordinator jobs in recent years.
Nevertheless, we’re glad the Commission put all these things on the record and showed, if nothing else, that they are of concern to state policymakers.
Update on the National Council on Disability’s anti-institutional bias
We wrote here before about the extreme ideological position of the National Council on Disability, which called last month for the closure of all residential facilities for persons with intellectual disabilities with more than three people living in them.
The NCD appears to be at it again, this time in the wake of the tragic shooting deaths of children and teachers in Newtown last month by a young man who may have had a mental illness or at least needed mental health treatment.
In a January 11 letter to Vice President Joe Biden, in Biden’s capacity as head of the president’s gun violence task force, Jonathan Young, chair of the NCD, appears to be more concerned about creating “an unnecessary expansion in institutionalization” than in ensuring that people who pose a danger to others get treatment or medication.
Young uses most of the letter to urge the vice president to avoid any measures that could unnecessarily institutionalize people, involuntarily commit them, or force treatment on them.
No one would disagree with Young’s contention in his letter that people who pose no risk of violence should not be subject to institutionalization or forced treatment. But Young says little about what the task force could or should do to protect everyone’s safety.
While COFAR’s mission is to advocate on behalf of people with intellectual disabilities, not specifically on behalf of people with mental illness, we are commenting on Young’s letter because much of the debate over deinstitutionalization of both groups of people has been similar. Certainly, Young and the NCD take the same view in favor of complete deinstitutionalization of both groups, and make the same flawed arguments about each.
In his letter to Biden, Young states that “institutional care has a long-standing history of poor outcomes and civil rights violation (sic) among persons with psychiatric disabilities.” At the same time, he bemoans a “profound shortage in community-based services” for people with mental illness.
There are a number of potential contradictions here. First, Young and many other institutional opponents gloss over the fact that many so-called community-based services are institutional in nature. The NCD, in fact, takes this viewpoint to an extreme. With regard to people with intellectual disabilities, the NCD has stated that even community-based group homes are institutional and should be closed down if they have more than three people living in them.
Young and the NCD can’t have it both ways. Young talks about a shortage of community-based services and yet he and the NCD want to dismantle much of the community-based infrastructure that exists for people with intellectual disabilities.
Secondly, while institutional care, whether of persons with psychiatric disabilities or intellectual disabilities, has certainly had its problems in the distant past, that care has come a long way. It’s deinstitutionalization, which has had the more checkered recent history and the poorer outcomes.
Here is an assessment in 2007 of the success or lack thereof of deinstitutionalization of the mentally ill, by the Kaiser Commission on Medicaid and the Uninsured.
The history of deinstitutionalization began with high hopes and by 2000, our understanding of how to do it had solidified. But it was too late for many. Looking back it is possible to see the mistakes, and a primary problem was that mental health policymakers overlooked the difficulty of finding resources to meet the needs of a marginalized group of people living in scattered sites in the community (my emphasis).
This marginalization of people living in scattered sites in the community is something we at COFAR have been saying for a long time with regard to people with intellectual disabilities. It’s distressing that the NCD, an independent federal agency that advises the president and Congress on disabilities issues, has apparently chosen to rewrite the real history of deinstitutionalization.
Young’s other major concern in his letter to Biden appears to be that safety-related measures under consideration by Biden’s task force, such as requiring colleges to refer students with perceived psychological disabilities for evaluation and institutionalization, might perpetuate a stigma or damaging stereotypes about mental illness. This concern on Young’s part appears to override his concern about the need such people might have for treatment.
We need to have a constructive discussion concerning the future of care for people with both mental illness and developmental disabilities. One way to begin is to stop the stereotypes and stigmas about institutional care.
COFAR blog 