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Like the Wrentham and Hogan Centers, Pappas remains open, but is its future truly secure?
In a striking parallel to the uncertainty surrounding the future of the Wrentham and Hogan Intermediate Care Facilities (ICFs), uncertainty lingers over the fate of the Pappas Rehabilitation Hospital for Children in Canton.
Governor Maura Healey has stated that she has paused her proposed closure of Pappas in the wake of strong opposition to the closure from unions and other advocates, including COFAR. The governor has made no formal statements regarding the future of Wrentham or Hogan, but we believe the fates of all three facilities are connected.
Back in June, we joined self-advocates, families, and staff members urging legislators to protect the hospital-school during a public hearing of a Special Legislative Commission tasked with investigating the long-term direction of the facility.
Many speakers offered testimony, but one message was apparent: concerns about restrictive admissions criteria, lack of new long-term admissions, and ongoing discharges have raised suspicions about a quiet closure of Pappas. The same dynamics are true involving Wrentham and Hogan.
Although comments during the legislative hearing appeared to indicate that the Healey administration has changed its course and is now embracing a collaborative approach to revitalizing the campus, it is unclear how this response has materialized in the months following the committee hearing.
With reportedly 12 long-term patients and no short-term respite patients today, 28 beds remain unfilled at Pappas in the face of statewide need. The question remains: is the closure of Pappas truly paused?
The situation at Pappas has staggering parallels to the trajectory of the Wrentham and Hogan Intermediate Care Facilities (ICFs), state-run developmental centers for adults with intellectual and developmental disabilities. The census at Wrentham has dropped from 323 residents in fiscal year 2012 to 132 today, while the census at Hogan has decreased from 155 to 82 during that same time frame.
As COFAR has previously reported, the administration is also allowing the Wrentham and Hogan Centers to die by attrition by denying admissions to all but a handful of applicants in recent years while their censuses steadily drop. Families report that they are not informed of ICF options or have their placement requests rejected. If these trends continue, closure of these facilities is inevitable.
During the legislative committee hearing, COFAR voiced concerns about the restrictive admissions process at Pappas and shared our experience working with families facing similar barriers at Wrentham and Hogan, encouraging commissioners to re-examine the policies that shape access to care.
The pattern opens broader concerns about the future of essential state-run services in Massachusetts.
Background on proposed closure of Pappas
Originally founded in 1904, Pappas Rehabilitation Hospital for Children, previously known as the Massachusetts Hospital School, provides medical care and educational, rehabilitative, and therapeutic services for children and young adults with multiple disabilities ages 7 to 22+.
The 166-acre campus boasts a variety of unique features specifically designed to accommodate the needs of individuals with disabilities, ranging from covered walkways for wheelchair maneuvering, a pool with ramps, and a rehabilitation engineering department creating customized equipment and assistive technology for residents. Moreover, the facility offers patients extensive recreational programming, including horseback riding, adaptive sports, and creative arts, as well as a bowling alley, electronic gaming room, and reservoir pond for waterfront activities.
In January 2025, Governor Healey announced in her FY ‘26 budget proposal that she planned to close the Canton facility due to “aging infrastructure” as detailed by a 2023 feasibility study administered by the state. A number of children would be moved to Western Massachusetts Hospital in Westfield, over 100 miles away, where a 25-bed, modernized pediatric wing would be established in the predominantly adult hospital. She said the decision was merely a “redirecting of services of care” and would save the state 31 million dollars.
These savings amount to 0.10% of the state’s 30.4+ billion dollar Executive Office of Health and Human Service’s (EOHHS) FY ‘25 budget.
An email from Pappas admin to families specified that other students could be transferred to alternate placements such as hospitals, nursing homes, group homes, or family homes. The Department of Public Health (DPH) reported that the facility at the time had 36 patients, over half of whom were over the age of 18 and already pending discharge to “more appropriate” settings.
DPH Commissioner Robbie Goldstein justified the decision by stating, “What we know is that many of those children actually could be better cared for, more safely cared for, more compassionately cared for at home.”
Healey’s plan faced public backlash before she visited Pappas for the first time in February and ultimately paused the closure later that month, first seeking to elicit feedback from stakeholders. Families and staff members emphasized the vital nature of the specialized services provided by Pappas and expressed concern that patients would be separated from their loved ones and Pappas’ 225 employees who might not be able to relocate two hours away. Many also vocalized frustration that they were never consulted about the decision.
State House leadership echoed this surprise, with Speaker of the House Ronald Mariano asserting that the closure plans came “out of the blue” and he “didn’t know anything about it.”
Now, Pappas can neither be closed nor have patient services reduced until the Special Legislative Commission, established by an amendment filed by Canton Representative William Galvin to the FY ’26 budget and subsequently extended, submits a report with its findings and recommendations by the end of the calendar year 2027. The Commission is led by Senator William Driscoll and Representative Marjorie Decker, co-chairs of the Joint Committee on Public Health. Other members include state officials, executive leaders, Pappas staff, and the parent of a current Pappas patient.
This Commission effectively builds on the work of the Pappas Working Group (PWG) previously convened by the governor. The PWG developed an October 2025 report assessing options for the campus in the wake of the closure pause, such as “re-imagining” the campus by expanding services, pursuing phased investments on campus, maintaining the status quo, lowering the level of care, and closing the facility.
Special Legislative Commission hearing
The Pappas Special Legislative Commission hosted its June 17 public hearing to gather personal accounts and other information that would guide its study into the facility’s future. The hearing lasted over four hours and united a diverse group of families, self-advocates, staff members, and public officials, nearly all, reiterating their observations of what appeared to be a de facto closure of Pappas. COFAR also testified during this hearing in support of maintaining the facility.
Commissioners seeking concrete steps to protect Pappas
In opening statements, several Commissioners urged for substantive actions to secure Pappas’ future.
Representative Galvin stated he was “very frustrated and angry with this administration and the way they have handled this situation.” He explained that he filed an amendment establishing the Special Legislative Commission in response to the Governor’s Pappas Working Group, which he believed was created to support the administration’s closure decision. Given the new commission’s formation, he expected the administration to begin examining possibilities for facility repairs following years of underfunding and offer ideas for possible partnerships with providers but received “nothing” from them. He said he hopes that the Commissioners will develop a concrete plan for directing money into Pappas as a result of these meetings.
Similarly, Senator Paul Feeney, whose district includes Pappas, commented that he was “a little bit talked out on this.” He acknowledged the value of the Commission but stressed that it is time to “start putting our money where our mouth is and making it happen” through funding decisions to reimagine Pappas.
Closure by attrition
The urgency for these substantive changes was illuminated by the declining census referenced across hearing testimonies.
Kim Daley, a special education teacher at Pappas and member of the Commission, described how a “clear shift” has taken place since the January 2025 closure announcement in her opening statement. She stated there has been “a noticeable and sustained focus on discharging patients while admissions appear to be effectively blocked and have not been approached with any comparable urgency.”
Jim Durkin, the Legislative Director of AFSCME Council 93, similarly identified a disconnect between the administration’s official position and the messaging staff conveyed to staff. “You hear one message from the top, and then when you get down on the ground, it’s an entirely different message down there and we keep hearing the same excuse: ‘It just hasn’t trickled down yet; we’re open for business.’ Again, I call B.S.,” he said.
Senator Paul Feeney cited a monthly report from the Department of Public Health showcasing a census decline from 35 to 21, with only 2 long-term admissions and 18 discharges between January 2025 and March 2026. All other admissions are occurring on a respite basis, with stays typically lasting no more than a couple of weeks. SEIU Local 509 President David Foley later clarified that the 2 intakes were actually students who were discharged within 2 months.
Speakers attributed this lack of new admissions to the Commonwealth’s narrow definition and application of “hospital level of care” criteria. Commissioner Nicole Friel, whose daughter currently attends Pappas, noted that she was told her daughter “would no longer meet the criteria for admission had she applied currently,” despite having the same medical condition. Friel questioned whether “we are somehow defining things differently now than we did in the past.”
Need for high-acuity care for children statewide
Massachusetts Nurses Association (MNA) President Katie Murphy asserted that these developments have transpired even with a “larger need” in the Commonwealth as reflected in the report issued by the Governor’s own Pappas Working Group. This report found that there are over 12,000 children in the state with medical complexity and under 2,000 beds available in the Commonwealth, leaving considerable children “stuck” in acute care hospitals over time.
“Needs of Special Needs Population” per Governor’s Pappas Working Group Final Report
Student regression in alternate settings
Speakers detailed how many students discharged from Pappas have been moved to settings unable to meet their needs despite objections from their families, teachers, and clinical team.
Caitlin Horrigan, a Pappas teacher for over a decade, highlighted student regression post-discharge. She recounted one student who shifted from independently navigating Pappas’ campus to using a wheelchair with a 1-1 support staffer in public school and suffering a medical event requiring extended hospitalization and surgery within one month of discharge from Pappas. Other students, she said, transferred to residential programs without comparable vocational opportunities, lost key IEP services, or were denied admissions from other residential schools because of their medical complexity. “Is this ‘the community’ DPH is talking about?… They deserve a least restrictive environment for them. I have yet to see a student ‘more compassionately’ or ‘better cared for’ when they left Pappas,” she exclaimed.
Jennifer Ford, a former Pappas educator, stressed the day-to-day realities many families with medically complex loved ones face. She said, “After hearing the DPH Commissioner claim that this population is cared for more compassionately at home and better served in the community, I’ve learned firsthand it’s just not that simple. These families are the toughest, most self-sacrificing people out there; the majority of the families I serve are single mothers, often with multiple children living in cramped apartments without wheelchair lifts or elevators. It is common for a parent to physically lift a grown child out of their wheelchair and carry them up multiple flights of stairs… but what about her quality of life?”
Numerous speakers underscored that Pappas is a vibrant community in its own right. Pappas graduate John Mariani recalled in his testimony that he “didn’t feel like [he] fit in with public school” but at Pappas, finally “belonged [and] fit in.”
Response from DPH Commissioner Robbie Goldstein
DPH Commissioner Robbie Goldstein, however, maintained that the facility is operating regularly. He said, “Let me be clear in this statement: we fully support keeping Pappas Rehabilitation Hospital open and stable while this Commission conducts its vital work. The Governor’s budget fully funded continued operations of Pappas. That means we are continuing admissions and appropriate discharges, backfilling staff positions as needed, avoiding layoffs, avoiding service reductions as the process to design the best future and the right future for caring for medically complex children in the state proceeds.”
He explained that the facility is facing “challenges,” most notably, physical infrastructural issues that limit the facility’s ability to serve children with higher medical and behavioral support needs, such as individuals who require mechanical ventilation or 24/7 monitoring.
Nevertheless, he noted that leadership has “not waited” to address some of these difficulties. He stated they hired a psychiatric nurse practitioner for the first time, staff developed marketing materials to broaden outreach, and they strengthened referral networks through site visits with various hospitals.
When questioned by Chair Driscoll about how the facility appears to be “depopulated” over time, Commissioner Goldstein replied that he “can’t speak to what prior admissions have done.” He stated that during his oversight, the DPH has adhered to hospital regulations that require patients to meet “a hospital level of care.” Failure to adhere to this standard, he said, would put the state in violation of its Medicaid contracts, risking fines and other penalties from the federal government. He acknowledged that monthly admissions have historically decreased but attributed this to the “reality of the legal structure we exist in as a hospital and the physical limitations of the plant.”
In response to staff reports that they have been informed of a future closure, Commissioner Goldstein insisted, “From the top of the Department of Public Health, we have been very clear that the hospital remains open,” and individuals who say otherwise “may not be listening to leadership” and current admissions procedures.
Executive commitment to “turning a new page” for Pappas
Commissioner Goldstein later acknowledged that the administration is supportive of a collaborative approach to facilitating investments in the Pappas campus. He stated, “Now we are in a place where we have accepted that there are solvable problems there and we need to come together to figure out how to get the right investment into that campus so that it can be safe for children to be there” while also identifying solutions for the other vulnerable children statewide.
Chair Decker expressed surprise at the apparent shift from considering whether the facility should be saved to discussing how to revitalize the campus with executive collaboration but applauded it as a “welcoming conversation” that would alter how the Commission moves forward, aiming to invite members of the administration to future meetings.
She added she hopes to see “layers” of action from the administration, including identifying necessary baseline renovations, providing the Commission data regarding admissions and denials, and communicating to staff that the facility is open so information will “trickle down to the bureaucracy.”
Federal support for Pappas
The legislative hearing even drew federal participation, with Congressman Stephen Lynch, whose district is home to Pappas, testifying before the Commission.
Congressman Lynch praised Pappas as “irreplaceable” and a “national model for pediatric rehabilitation care.” He voiced frustration that federal assistance was not previously sought to maintain the facility, stating, “The leadership at Pappas has never asked me for money, never asked me for an earmark… that bothers me that we are not robustly and vigorously fighting for every single dollar we can get for that facility… We could do this building by building.” He vowed to “pursue every available federal resource to help the Commonwealth find a path forward that does not require the closing of this facility,” embracing a phased investment approach to redeveloping Pappas.
“Dear God, if we can’t help these people, what the hell are we doing… we need to step up and do the right thing,” he remarked.
Reality today
In the months following the legislative committee hearing, it is unclear how the Healey administration has changed its course to ensure Pappas’ longevity, as discussed during the hearing, although there have been some successes in the legislature.
Legislative developments
Through the legislative process, the final FY ‘27 budget, enacted July 9, fully funded the facility and extended the appointment of the Pappas Special Legislative Commission for another calendar year. However, additional efforts to obtain long-term capital investment in the facility have had mixed results. In the House version of the July economic development bill (H.5562), Representative Galvin filed an amendment proposing the establishment of a capital grant program to upgrade the Pappas infrastructure and the creation of a five-year capital plan. This amendment was not incorporated in the final version of the House bill.
In the Senate, meanwhile, an amendment filed by Senator Feeney seeking 2 million dollars for Pappas facility repairs and upgrades to increase admissions was adopted as part of the Senate’s economic development bill (S.3178) later that month. The bill is currently in conference committee. If advanced, the funding could help address longstanding infrastructure issues at Pappas, including the pool, which remains in disrepair, restoring student access to critical water therapies. Current alterations include repairing the clocktower and refacing and painting the pergolas.
Limited long-term admissions and ongoing discharges
There is limited evidence of meaningful progress in increasing long-term admissions.
In light of Commissioner Goldstein’s comments that Pappas is open and accepting admissions, members of the Pappas community took to social media to share information about the application process. On July 1, they celebrated that Pappas had received its first long-term admission in almost a year. That month, the exterior Pappas signage featured new postage “Accepting Admissions,” seemingly opening the doors to new students.
In an interview with Michael Poirier, a former Pappas student and staff member for decades, he revealed that the reality on the ground is much different. When Pappas students began the new school year, they were joined by only 11 long-term patients and 4 short-term respite patients, with multiple students slated for discharge in the first few weeks. 29 empty beds remained. He said at the time the July admission reflected the only new admission after the Special Legislative Commission hearing, with 6 discharges occurring since that time.
Today, there are reportedly 12 long-term patients and no short-term respite patients, with 28 empty beds.
This lack of new admissions has continued even in the face of demand for placement. Poirier said that the administration has “absolutely not” changed course to work collaboratively with the Special Legislative Commission as discussed during the hearing or achieve meaningful increases in admissions as aligned with Commissioner Goldstein’s claim that Pappas is open and accepting new admissions. He said it took until the beginning of October for the DPH to provide the Special Legislative Commission the information it requested during the June hearing regarding patient referrals and denials. He added approximately 20 long-term admission referrals have been denied over the past year, even when the admissions committee voted to accept the patients, since the decisions were overruled by Commissioner Goldstein and his team at the DPH and Pappas. This includes an individual who has reportedly been in an acute care hospital in Boston for over 100 days and is recognized by Boston physicians as meeting the criteria for “hospital level of care.”
While the Governor’s team has stated that there is a commitment to keeping Pappas open as the Special Legislative Commission continues its work, he said, “Indecision and failure to make important meaningful decisions that will meet the needs of those Pappas serves, could serve, or will keep the doors open undermines the Governor’s public commitment and is nonsense.” He urged infrastructural investments to improve existing buildings, opening the outpatient program, and a “true plan” to diversify the campus and meet the needs of people of all abilities across state agencies as the path forward. He noted a plan to reopen outpatient services was previously submitted to DPH leadership in May; however, no action appears to have been taken by the Department.
Healey administration assuring commitment to reimagining Pappas
During her remarks at AFSCME Council 93 Legislative Conference in September, Governor Healey reiterated the administration’s collaborative approach to reimagining the facility. She said, “I know people haven’t been happy about Pappas. Pappas was underinvested in for decades, okay. Now I think we’re in a good place; we’re having the conversations, we’re thinking about, with your input and involvement, how do we reimagine Pappas… We are going to do something good there, I can promise you that.”
In early October, a member of DPH leadership reportedly recognized the need for new admissions to Pappas and apologized to staff for some of the challenges occurring throughout the year. Soon after, the Chief Medical Officer (CMO) for DPH hospitals visited Pappas alongside other EOHHS officials.
In an October 10 weekly update from Representative Decker, she highlighted that she met with the legislative delegation and Healey administration officials to discuss the future of Pappas as part of the Special Legislative Commission’s ongoing work.
The Press Offices of Governor Healey, the Executive Office of Health and Human Services, and the Department of Public Health did not respond to my request for comment on the status of Pappas.
Similar circumstances at Wrentham and Hogan Intermediate Care Facilities (ICFs)
Ambiguity surrounding the status of Pappas also clouds the prospects of other state-run facilities. Although formal closure plans have yet to be announced, the future of Wrentham and Hogan Intermediate Care Facilities (ICFs) for adults with intellectual and developmental disabilities remains fraught.
Families indicate that they are not informed of the existence of these facilities and are denied placement. It is only through media coverage or attorney involvement that we have seen the few accepted individuals gain entry.
Meanwhile, the census continues to decrease. Wrentham’s census dropped from 323 residents in fiscal year 2012 to 132 today, while Hogan’s declined from 155 residents to 82 during the same period.
Even if Pappas is ultimately preserved, the loss of Wrentham, Hogan, and the similarly dwindling state-operated group home network will eliminate other high-acuity adult care options for Pappas patients aging out of the system.
COFAR raised concerns about admission policy restraints at Pappas and detailed similar impediments at Wrentham and Hogan during the Special Legislative Commission hearing, asking commissioners to review the policies impacting care access. The overlap presents wider concerns about the fate of important state-run services in the Commonwealth.
While we are working in the legislature to preserve Wrentham and Hogan and are interested in exploring the establishment of a legislative commission dedicated to their future, it appears that the efficacy of such a commission will depend on the administration’s willingness to collaborate.
Continued advocacy to protect Pappas, Wrentham, and Hogan
We are urging our members to contact their state legislators and encourage them to call for the Legislative Commission to begin working on a long-term plan for the future of Pappas Rehabilitation Hospital for Children.
Also, please ask the Commission to consider investigating restrictive admissions to other key state-run placements for people with disabilities, including the Hogan Regional Center and Wrentham Developmental Center. The patterns across these placements point to larger issues within the EOHHS involving patient access to care.
Let the Commission know that even if Pappas survives, the question remains where its residents will go when they turn 22 and age out of that care. If Wrentham and Hogan are closed, a critical option for residential care will have been lost permanently not only to those Pappas residents but to all persons with intellectual and developmental disabilities in Massachusetts.
You can find your state legislators here: https://malegislature.gov/Search/FindMyLegislator
Additionally, we ask that you consider contacting Governor Healey’s office and encourage her administration to work collaboratively with the Legislative Commission by taking tangible steps to protect all of these valuable assets.
You can contact Governor Healey’s office at (617) 725-4005.
Controversial U.S. Department of Justice memo offers support for Intermediate Care Facilities
A new legal memorandum from the U.S. Department of Justice signals a change in philosophy in the federal government toward supporting Intermediate Care Facilities (ICFs) for individuals with intellectual and developmental disabilities (I/DD), such as the Wrentham and Hogan centers in Massachusetts.
The memo, which was issued on June 18 by the DOJ’s Office of Legal Counsel, has ignited a firestorm of dissent among disability advocates who support the closures of ICFs. It has even generated concern among some supporters of ICFs who say the memo may nevertheless have gone too far in preventing community-based placements.
Overall, the DOJ memo appears to validate what we have said for years, which is that the 1999 Olmstead v. L.C. U.S. Supreme Court decision did not order states to close ICFs and place everyone in the community-based system of residential care.
We have argued that eligible individuals with I/DD have a federal right to ICF care; yet the state Department of Developmental Services (DDS) has blocked almost all admissions in recent years to the Wrentham and Hogan centers. As a result, those facilities are continuing to lose residents and are on a closure trajectory.
As we have maintained, DDS and other opponents of ICF care have misrepresented the Olmstead decision as ordering an end to all institutional care.
The DOJ memo argues that neither Title II of the federal Americans with Disabilities Act (ADA) nor Olmstead created or upheld a community “integration mandate,” and that Olmstead held that institutionalization is not discriminatory if it is justified by factors such as the individual’s needs and resource limitations in the community.
As the DOJ memo stated in its interpretation of Olmstead,
Before committing a patient with mental disabilities to an institution—or upon request for a transfer by a patient currently institutionalized—states should assess the appropriateness and feasibility of both institutional and community-based treatment options and make a decision based on a non-arbitrary rationale. (Our emphasis)
We support both the ICFs and the community-based system
We agree with the following statement made by our partner organization, The Saving Wrentham and Hogan Alliance, in a recent analysis of the DOJ memo:
We do not believe that congregate care is inherently superior to community-based living, or that families who choose Home and Community Based Services (HCBS) are making a wrong choice. We believe in choice — genuine, funded, legally secured choice — and we believe that choice is the mechanism through which quality in any service system is actually produced.
The problem is that Massachusetts and other states, inappropriately citing Olmstead, have been letting ICFs like Wrentham and Hogan slowly die by attrition. This threatens to eliminate a critical backstop for care in the overall DDS system.
The DOJ memo took note of the potential danger in eliminating congregate care by highlighting a claim by Justice Anthony Kennedy of a “dark side of deinstitutionalization.” Kennedy made the claim in a concurring opinion in Olmstead in which he wrote that “patients prematurely released from in-patient care frequently end up homeless or even incarcerated.”
In addition, we think the DOJ memo correctly criticized a previous longstanding practice of the Justice Department’s Civil Rights Division of using “its integration mandate and Olmstead to pressure states into discharging individuals from mental-health institutions.” We have long raised similar concerns. As we said in 2015, “The DOJ seems to have closed its eyes to the realities on the ground in continuing to file lawsuits around the country to close state-run care facilities.”
More recently, in December 2024, we wrote to U.S. Health and Human Services Secretary Robert F. Kennedy Jr., asking whether he would commit “to changing the direction in which HHS (the Department of Health and Human Services) and the DOJ have long been headed in furthering the runaway privatization of human services and the closures of state-run services for people with I/DD, including Intermediate Care Facilities.”
Concerns about the DOJ memo
Some advocates have argued that the DOJ memo has gone too far in its support of institutional care by interpreting Olmstead in a way that may make it more difficult for people with I/DD to access community services. It has been suggested that the memo has set an overly high bar for community services because the memo interprets Olmstead as stating that institutional care is discriminatory only if it is solely based on a person’s disability and is not necessarily discriminatory if it is based on the person’s needs.
As we understand it, the concern is that the DOJ is now interpreting Olmstead in a way that could make it more likely that persons with certain needs will be placed in institutions even if they want to be in the community.
At least some of that concern centers around the DOJ memo’s recommendation to rescind a regulation under the ADA which requires states to move institutionalized patients to “the most integrated setting appropriate to the needs of qualified individuals with disabilities.” Many advocates are concerned that rescinding this regulation will remove any impetus a state may have to place clients with I/DD in integrated settings.
While we share that concern, we would note that the DOJ memo states, “Before committing a patient with mental disabilities to an institution—or upon request for a transfer by a patient currently institutionalized—states should assess the appropriateness and feasibility of both institutional and community-based treatment options and make a decision based on a non-arbitrary rationale.” (Our emphasis)
This statement in the memo appears to demonstrate an even-handedness in assessing the appropriateness of institutional and community-based care.
The three-part test
We do recognize that there is some additional disagreement among advocates with the DOJ memo’s conclusion that Olmstead did not establish clear criteria for what justifies institutional versus community placement. There appears to be legitimate debate over that claim in the memo — particularly over the memo’s analysis of the three-part test suggested by Justice Ruth Bader Ginsburg in Olmstead for requiring placement of an individual in the community.
Ginsburg wrote that community placement is required when (1) an individual’s “treatment professionals determine that such placement is appropriate,” (2) that individual “do[es] not oppose such treatment,” and (3) “the placement can be reasonably accommodated, taking into account the resources available to the State and the needs of others with mental disabilities.”
The DOJ memo stated that Ginsburg’s three-part test was approved only by a plurality and not a majority of the Court, and “thus, Olmstead did not conclusively resolve which justifications a state may offer in defense of its treatment choices—it held only that institutionalization must be ‘justified.’”
While many advocates contend the ADA regulations do conclusively establish the justifications needed for institutional care, we would note that the DOJ memo does go on to state that a majority of the Court did agree that the three-part test is “relevant” in justifying institutional placement. As the memo stated:
The majority opinion (in Olmstead) certainly references “the reasonable assessments of [a state’s] professionals” and patient “desire” as relevant to the question of whether institutionalization—that is, the provision of care in an in-patient setting, typically over the medium or long term—is justified in a given case…But not even the Olmstead plurality held that Title II makes maximal integration obligatory based on these factors alone.
The DOJ memo further stated that,
Indeed, the majority explained that it offered these factors (three-part test) to ’emphasize that nothing in the ADA or its implementing regulations condones termination of institutional settings for persons unable to handle or benefit from community settings.’ Read in this light, the opinion permits treatment in an institution based on professional assessment and patient consent. It does not say that these factors are the only acceptable justifications.
A recognition of history
The proponents of complete deinstitutionalization are overlooking the history of residential care in Massachusetts and throughout the country of people with I/DD since the 1980s. In particular, those proponents are missing the role played in Massachusetts by the late U.S. District Court Judge Joseph Tauro in overseeing the landmark litigation — Ricci v. Okin — which brought about significant improvements in the care and conditions at those facilities.
Tauro noted in his 1993 disengagement order from the case that both the major capital and staffing improvements to the facilities and a program of community placements had “taken people with mental retardation from the snake pit, human warehouse environment of two decades ago, to the point where Massachusetts now has a system of care and habilitation that is probably second to none anywhere in the world.”
Ironically, it is the community system has now become the new warehouse system for thousands of people with I/DD. We hear countless accounts of abuse, neglect, and poor conditions in group homes. This is happening while the executives of corporate residential provider agencies make exorbitant salaries and pay their direct care workers low wages and provide them with inadequate training.
The main danger isn’t that people with I/DD will be forced into institutional care, but that the community-based system has never had the staffing, expertise, or oversight necessary to replace the institutional system entirely. As we have seen in case after case, group homes cannot handle clients with the most severe and profound levels of I/DD and the most complex medical problems. That is why the ICFs remain so critically important.
In the final analysis, we would agree that we shouldn’t put all of our faith and focus on the DOJ memo in continuing to advocate for the preservation of ICFs. But we can use the memo’s conclusion as one more argument in our quiver in support of the assertion that there is a right to ICF-level care in Massachusetts and elsewhere.
Those arguments asserting that right can also be found in the Medicaid statute (42 U.S.C., § 1396a(a) (8)), which states that if a state includes an ICF in its Medicaid Plan, it must provide that service promptly to all eligible individuals. In addition, the right to ICF care is found in the Boulet v. Cellucci federal court decision (107 F. Supp. 2d 61 (D. Mass. 2000), and in the Medicaid regulations, 42 C.F.R. § 441.302(d), which explicitly require the choice of either institutional or HCBS care.
All of these are arguments we can bring if we do file or join in a lawsuit or as we continue to make our case to the Legislature that ICFs should be preserved and open their doors to persons who need and desire that level of care.
Advocacy continues following Senate budget decision on Wrentham and Hogan amendments
Our two budget amendments aimed at preserving the Wrentham and Hogan Intermediate Care Facilities (ICFs) for adults with intellectual and developmental disabilities ultimately did not move forward in the Massachusetts state Senate during its debate last month on the Fiscal Year 2027 state budget.
This outcome was not unique; out of the 1,158 amendments filed to the Senate budget, more than half were either withdrawn or rejected. Senate Ways and Means Committee Chair Michael Rodrigues previously indicated that “there is not a ton of room for amendments” this budget cycle.
The amendments, 411 and 555, filed by Senate Minority Leader Bruce Tarr and Senator Becca Rausch, would have altogether affirmed a right to care at Wrentham and Hogan for persons found to be eligible for ICF-level care, required the Department of Developmental Services (DDS) to report on its efforts to offer these settings as a choice for residential care, and protected current ICF residents from involuntary discharge.
In both the House and Senate, the adoption of budget amendments are subject to decisions by the legislative leadership. Most amendments are voted on in bundles, and only a limited number are formally considered by the full chamber. As a result, our amendments were not individually debated or voted on in either chamber.
Our budget language was consistent with federal law and aligned with DDS’ movement toward “self-direction,” which expands the role of individuals and families in the planning and selecting of services.
The Senate results follow our amendment effort in the House. There Representative Marcus Vaughn filed three amendments containing our language (amendments 695, 699, and 703). Although the amendments received the bipartisan support of 19 legislative co-sponsors, they also were not adopted.
Because our amendments did not advance in the House or Senate, our language will not be incorporated into the FY ‘27 state budget. However, we are hopeful that we have laid the groundwork for the reintroduction of our proposed language next year to save the Wrentham and Hogan facilities.
We are pleased that during this year’s budget debates, nearly a quarter of the Senate formally engaged on this issue by either sponsoring or co-sponsoring the amendments. It is encouraging to know that we are spreading awareness across the legislature, which oversees state agencies such as DDS. As noted, we believe this sets the groundwork for future legislative advocacy efforts.
This year marked our first sustained attempt to modify the state budget language.
Senate amendment co-sponsors
We would like to thank Senate Minority Leader Bruce E. Tarr (R, First Essex and Middlesex) and Senator Rebecca L. Rausch (D, Norfolk, Worcester and Middlesex), the principal sponsors of our amendments, along with the following co-sponsors:
Senator Pavel M. Payano, D, First Essex
Senator Jason M. Lewis, D, Fifth Middlesex
Senator John F. Keenan, D, Norfolk and Plymouth
Senator James B. Eldridge, D, Middlesex and Worcester
Senator Nick Collins, D, First Suffolk
Senator William J. Driscoll, Jr., D, Norfolk, Plymouth, and Bristol
Senator Vanna Howard, D, First Middlesex
COFAR member outreach
We additionally would like to thank our COFAR members for their tireless advocacy. Whether emailing or calling their state senators, sharing our posts on social media, or encouraging others to contact their legislators, we were heartened by the outpouring of support. Your help was essential to the progress that we were able to achieve this year. Thank you for sharing your stories and perspective.
Future legislative advocacy efforts
We will work to enact this language again next year since we believe the facilities are in danger of closure.
The Wrentham and Hogan centers offer a high level of federally regulated care for individuals with some of the most profound disabilities. They also provide more than 1,000 jobs for direct care workers, clinicians, medical personnel, and others, according to the latest data available from DDS.
The population at both facilities has decreased significantly, however. Families report that they are not informed of ICF options or have their placement requests rejected. If these trends continue, closure of these facilities is inevitable.
It was only last year that Governor Maura Healey announced the proposed closure of Pappas Rehabilitation Hospital for Children, a state-run residential hospital for children with disabilities that is reportedly now experiencing similar restrictions on admissions. We remain committed to safeguarding essential state-operated services for people with disabilities amid rampant privatization.
We encourage you to continue sharing your perspective with legislators to keep attention on this issue. If you are interested in participating in future legislative advocacy efforts, please contact us at info@cofar.org. Together we can preserve the Wrentham and Hogan centers.
House leadership rejects the right to care at Wrentham and Hogan Centers
Under the state Legislature’s less-than-fully-democratic state budget process, our budget amendments to preserve the Wrentham and Hogan Intermediate Care Facilities (ICFs) were rejected last week in the House of Representatives without either a vote or debate on any of them.
It was frustrating because our amendments had garnered bipartisan support before each was stripped of its language by the House leadership. There were 18 cosponsors of our primary amendment, including 12 Democrats and 6 Republicans. There were 16 cosponsors of each of two other amendments that had been filed on our behalf.
The good news is the battle to preserve the ICFs now shifts to the state Senate, which is scheduled to debate its version of the Fiscal Year 2027 state budget starting the week of May 18. The bad news is, it might be difficult to find a senator to file our primary amendment, which would affirm a federally sanctioned right to residential placements in ICFs such as Wrentham and Hogan.
Last week, the leadership in the House assigned our amendments to a large “consolidated amendment,” which included dozens of amendments involving “public health and mental health and disability services.” However, the leadership then stripped the language in our amendments from the consolidated amendment.
Under the consolidated budget amendment process in the House, the House leadership places the vast majority of the thousands of individual amendments filed by House members each year in a small number of consolidated amendments. The leadership then decides what language from those individual amendments it wants to preserve, and allows up or down votes on the consolidated measures. Those consolidated amendments are always approved.
While individual legislators can lobby the leadership for approval of their amendments, it is ultimately the leadership’s decision whether to allow individual votes on the amendments or simply strip the language from them.
Our primary amendment, which had been filed Representative Marcus Vaughn, would ensure a choice and right to ICF care for those who have been found to be eligible for it. That amendment and our two related amendments were filed on our behalf by Vaughn, whose district includes Wrentham.
Among the cosponsors of each of the amendments were House Minority Leader Bradley Jones; and Democratic Representatives Lisa Field, a member of the Mass. Nurses Association, and Sally Kerans, who represents the Town of Danvers in which the Hogan Regional Center is located.
We think the reason our amendments were rejected has to do with the likely opposition to them by the Department of Developmental Services (DDS). As we have reported, the administration rarely allows admissions to either Wrentham or Hogan, and has been allowing those facilities to die by attrition. Yet these facilities are Medicaid certified centers that provide residential care, which the late federal District Court Judge Joseph Tauro described as “second to none anywhere in the world.”
While it seems unlikely that we will gain passage this year of our budget language asserting a right to ICF care – at least partly due to the lack of true democracy in the legislative process – our longer-term hope is to lay the groundwork for passage of the language next year. But time is running out for Wrentham and Hogan, given that their residential populations, or census, have been steadily declining.
We are urging our members to email their state senators as soon as possible, and ask them to agree to file an amendment to establish a right to ICF care for those who are eligible for that level of care. We will follow up with every senator who expresses a willingness to file such an amendment.
You can find your state senator here.
In sum, it is a troubling statement about the Massachusetts legislative process that a small number of legislative leaders can foreclose the opportunity for separate votes and debate on measures that have significant support in the chambers. It reduces the input of the rank and file membership of the Legislature, and, even more importantly, of the public whom those legislators represent.
In our amendments, we are not seeking more funding for programs — we are seeking just the affirmation of a common sense right that is already established in federal law. We hope the Legislature will ultimately support that right, and the administration will finally see the matter in that light as well.
Cosponsors in the house of our amendments
We would like to thank Representative Marcus Vaughn, the principal sponsor of our amendments, and the following cosponsors in the House of our primary amendment, and, in most cases, our additional amendments. They are Representatives:
Bradley H. Jones, Jr. R, Reading, House minority leader
Lisa Field, D, Taunton
John J. Marsi, R, Worcester
Sally P. Kerans, D, Danvers
David T. Vieira, R, Bourne
Lindsay N. Sabadosa, D, Northampton
Michael J. Soter R, Uxbridge
Natalie M. Higgins, D, Leominster
Amy Mah Sangiolo, D, Newton
James K. Hawkins, D, Attleboro
Norman J. Orrall, R, Berkley
Kate Donaghue, D, Northboro
Adam J. Scanlon, D, North Attleboro
David Allen Robertson, D, Tewksbury
Michael S. Chaisson, R, Foxboro
Paul McMurtry, D, Dedham
Greg Schwartz, D, Newton
David Henry Argosky LeBoeuf, D, Worcester
An additional House member, Representative Simon Cataldo, D, Carlisle, cosponsored one of our amendments, which would require DDS to report to the Legislature on steps taken to inform families of choices for care, including ICF residential care.
Bipartisan support grows for our budget amendments to save Wrentham and Hogan Centers
As the state House of Representatives begins debate today on the Fiscal Year 2027 state budget, we are gaining bipartisan support for our proposed amendments asserting a right of persons with intellectual and developmental disabilities (I/DD) to placements at the Wrentham and Hogan Intermediate Care Facilities (ICFs).
This is a right that not only aligns with federal law, but is consistent with the state’s policy of encouraging “self-direction” among clients in planning and choosing their services.
When it comes to Wrentham and Hogan, not only does the Department of Developmental Services (DDS) not inform disabled individuals and their families of the existence of those facilities, but the Department implies they don’t have a right to placements there.
Wrentham and Hogan are the last two remaining ICFs for persons with I/DD in Massachusetts, and we are concerned that the centers are heading toward closure.
As of today, 12 legislators have indicated their support for Amendment 695, which states that people with I/DD, who have been found to be eligible for ICF-level care, have a right to placement in an ICF residential setting.
A second amendment, which has also gathered the same cosponsors (Amendment 699), requires DDS to report on its efforts to inform families of all residential choices available for care, including ICF care. And a third amendment (Amendment 703) states that residents of ICFs cannot be involuntarily discharged from those facilities.
The cosponsors so far consist of six Democrats and six Republicans, including Republican Representative Marcus Vaughn, the principal sponsor of each of the amendments. Vaughn represents a district that includes the Wrentham Developmental Center.
Among the cosponsors are:
Representative Bradley Jones, a Republican from North Reading, and the House minority leader
Representative Lisa Field, a Democrat from Taunton, who is also a member of the Mass. Nurses Association. The MNA is supporting the effort to keep Wrentham and Hogan open
Representative Sally Kerans, a Democrat from Danvers, in which the Hogan Regional Center is located
Representative John Marsi, a Republican from Worcester
Representative Lindsay Sabasdosa, a Democrat from Northampton
Representative David Viera, a Republican from Bourne
Representative Michael Soter, a Republican from Bellingham
Representative Natalie Higgins, a Democrat from Leominster
Representative Amy Mah Sangiolo, a Democrat from Newton
Representative James Hawkins, a Democrat from Attleboro
Representative Norman Orrall, a Republican from Lakeville
We would urge all 160 House members to support these amendments because the language in them stakes out a commonsense position in favor of individual choice. We have always advocated for a full continuum of care for the most vulnerable citizens among us.
As advocates of the Wrentham and Hogan Centers have long pointed out, one size does not fit all. Community-based group homes can be the best choice for many, if not most, people with I/DD. But for a segment of that population, the community system is either not desired or it cannot meet their complex needs.
There can be no clearer example of that than the case of Kristen Robinson, who has been denied admission to Wrentham even though she is legally blind, quadriplegic, and has profound ID and complex medical issues. No community-based residence or nursing home could or would provide residential care for her.
Kristen was finally admitted to Hogan, after a months-long battle by her family, where she is now thriving.
But Kristen is the exception. Potentially, thousands of persons are waiting in Massachusetts for residential placements, and neither Wrentham nor Hogan is being offered as an option to them.
Questionable claim of cost savings
A series of administrations has long argued that closing congregate care facilities and placing residents in group homes saves money. But this argument is short-sighted and misleading.
As a recent report by our partner organization, the Saving Wrentham and Hogan Alliance, has shown, comparisons of the cost per resident of group home and ICF residents are comparisons of apples to oranges. ICF costs are reflected in the ICF line item in the state budget each year. Those include staffing costs, clinical care, food, housing, and facility costs.
In contrast, the costs of serving people in group homes show up in several state and federal budgets, including MassHealth, Housing and Urban Development (HUD) subsidies and in SNAP benefits, in addition to the DDS community residential line item.
The Saving Wrentham and Hogan Alliance report makes the overall point that the community-based group home system incurs an estimated $1.3 billion in taxpayer costs each year that are not included in the overall $3.3 billion DDS budget.
The DDS line item for corporate group home providers has doubled from a decade ago to more than $2 billion in the current fiscal year. During that same period, the line item for the Wrentham and Hogan facilities has declined by about 14% to roughly $130 million.
So where is the savings in closing ICFs and placing people in the group home system?
Right to an ICF
The assertion in Amendment 695 that ICF-eligible individuals in Massachusetts have a right to placement in an ICF aligns with the establishment of that right in the federal Medicaid Law and regulations.
The landmark Boulet v. Cellucci federal court decision (107 F. Supp. 2d 61 (D. Mass. 2000) cites the Medicaid statute (42 U.S.C., § 1396a(a) (8)), and explicitly states, “…to the extent that the plaintiffs have requested ICF/MR (now ICF/IDD) services, the state must provide those services reasonably promptly.”
The Boulet decision, which was written by U.S. District Court Judge Douglas Woodlock, required DDS to provide residential services promptly to thousands of clients who had been waiting for placements, in some cases for years. Unfortunately, the decision hasn’t led to a resolution of the problem. Not only are people still waiting months or years for placements, but DDS is badly underutilizing its state-run residential resources, which could help mitigate the problem.
DDS’s policy of personal choice
The right to choose an ICF also aligns with DDS’s stated policy that individuals and their guardians should be able to “self-direct” their care. The DDS’s Self-Directed Services website page contains the following statement:
DDS helps an individual to have more control in their life and to make decisions about services based on their vision, path, preferences, beliefs and abilities. The individual decides who helps them and how they want that help to be provided, based on what they want in life and their personal goals.
Placement in an ICF should be a part of that choice.
Connection to fight to preserve Pappas
Finally, we believe there are a number of parallels between the Healey administration’s reported policy of restricting admissions to the Pappas Rehabilitation Hospital and its policy of denying most requests for placement at Wrentham and Hogan.
In sum, our budget amendments are intended to preserve choice and to ensure respect for the wishes and preferences of DDS clients and their families. We hope all 160 House members would agree that the right to a choice of residential options along the entire spectrum of care should be respected and upheld.
Please continue to call or email your House member and ask them to cosponsor or sign onto Amendments 695, 699, and 703. You can find your legislator here. Thanks!
The Wrentham and Hogan Centers should be on the preservation list along with the Pappas Rehab Hospital
We are supporting the efforts of a number of unions and other advocates for the disabled to save the Pappas Rehabilitation Hospital from closure.
We are also pushing, at the same time, to add the state’s two remaining Intermediate Care Facilities for persons with intellectual and developmental disabilities (ICF/IDDs) — the Wrentham Developmental Center and the Hogan Regional Center — to the list of endangered facilities that must be preserved in Massachusetts.
There appear to be a number of parallels between the Healey administration’s reported policy of restricting admissions to the Pappas Hospital, and its policy of denying most requests for placement at Wrentham and Hogan.
The administration has placed “overly restrictive admissions criteria” at Pappas, according to nurses there. It is a policy that is likely to lead to Pappas’s closure.
As we have long reported, the administration is similarly allowing the Wrentham and Hogan Centers to die by attrition by denying admissions to all but a handful of applicants in recent years.
The 60-bed Pappas Rehabilitation Hospital in Canton offers medical, rehabilitative, educational and recreational services for persons with developmental disabilities up to the age of 22. In January 2025, Governor Maura Healey did announce that she planned to close the facility in order to save money and move the hospital’s programs to the state-run Western Massachusetts Hospital in Westfield.
COFAR joined state employee unions in opposing the governor’s closure of Pappas. That opposition prodded the administration to reverse its public stance. Healey is now saying she has no plans to close the facility, but the nurses there contend the governor’s statements don’t match the administration’s actual policy.
Last month, staffers at Pappas cast a vote of no confidence in Public Health Commissioner Robbie Goldstein in light of the Public Health Department’s alleged efforts to restrict admissions there, the Boston Herald reported.
Denials of admissions at both Pappas and the ICFs
The administration maintains the allegations of restricted admissions at Pappas are “inaccurate and (an) unhelpful escalation.” But the Herald reported that a mother’s request for admission to Pappas of a 12-year-old boy with severe disabilities had been denied. The boy is nonverbal, blind, and has other medical complications.
The Department of Developmental Services (DDS) has similarly routinely denied requests by family members to gain admission of their loved ones to Wrentham and Hogan. One of those cases involved Kristen Robinson, who is profoundly intellectually disabled, legally blind and quadriplegic, and has a seizure disorder and severe dysphagia, a medical condition that causes an inability to swallow.
DDS initially denied multiple requests by Kristen’s sisters, Kim Meehan and Karen Brady, to get Kristen admitted to the Wrentham Center. It was only through exhaustive efforts that included contacting the media, that Kim and Karen were able to get Kristen into Hogan, where she is now thriving. DDS has continued to deny Kim’s and Karen’s requests to place Kristen at Wrentham, which is much closer to where they live.
It also appears that the legal and internal appeals divisions at DDS have a bias against families and guardians seeking admission of their loved ones to Wrentham and Hogan. In at least two cases, a DDS hearing officer denied appeals by families to transfer intellectually disabled persons from corporate, provider-run group homes to Wrentham.
In both cases, the same DDS hearing officer denied the appeals in rulings that used much of the same language, and discounted concerns raised by the families about a lack of adequate care and meaningful activities in “community-based” group homes and day programs.
In both cases, the hearing officer stated that the individuals did not have a right under federal law to placement in an ICF. Also, in each appeal, DDS stated that it was restricting admissions to ICFs to cases “where there is a health or safety risk to the individual or others, and generally, when all other community-based options have been exhausted.”
COFAR is, as a result, urging state lawmakers to adopt language in the state budget, asserting the right to ICF care for all persons who have been found to be eligible for that level of care.
Rhetoric not matching policy
In the case of Pappas, the administration is insisting that there are no admissions restrictions. The Herald quoted a spokesperson for the governor last month as saying:
Pappas continues to operate as usual, with new patients being admitted and patients being appropriately discharged when they finish their treatment. In fact, the Commissioner has been actively notifying providers of space available for new patients to be admitted at Pappas, and will continue to do so.
At a recent call-in show on Boston Public Radio, Governor Healey made a similarly reassuring statement to a COFAR advocate who asked whether the governor planned to keep the Wrentham and Hogan Centers open. Healey responded, saying, “Rest assured, there are no plans to close any facilities in Massachusetts.”
But the advocate wasn’t given the opportunity on the call-in show to ask any follow-up questions, such as why DDS routinely denies admission to the Wrentham and Hogan centers, and why there has been a steadily declining number of residents, or census, in facilities as a result.
The census at Wrentham dropped from 323 in Fiscal 2012, to 143 in Fiscal 2025 – a 56% drop. The census at Hogan dropped from 155 in Fiscal 2012, to 84 in Fiscal 2025 – a 46% drop.
We are urging all of the advocates for the preservation of Pappas to join us as well in fighting to preserve Wrentham and Hogan. Email or call your House member and urge them to support the upcoming budget amendment establishing a right to care in Wrentham and Hogan. You can find your legislator here.
Saving Pappas and saving Wrentham and Hogan are all a part of the same battle. It is a battle to stop the runaway privatization of state-run care and the race to the bottom in standards that will result from the closure of those state-run facilities.
New book gives a fair-minded account of Walter Fernald, yet unfairly attacks the Fernald Developmental Center
There is a strange dichotomy in a new book by writer and anti-congregate care activist Alex Green about the professional life of Walter E. Fernald, the first superintendent of what was later to become the Fernald Developmental Center.
On the one hand, “A Perfect Turmoil: Walter E. Fernald and the Struggle to Care for America’s Disabled,” offers a largely positive and sympathetic account of Walter Fernald, who took the reins in 1887 of what was then called the Massachusetts School for the Feeble Minded.
Green portrays Fernald as a complex figure—capable of compassion, self-reflection, and change—as he engaged with the flawed scientific ideas of his time.
In contrast, the book paints the Waltham-based Fernald Center itself in a uniformly negative and what we consider to be unfair light, branding it at the outset of the book as “a nightmare” and “a place of shame.” That stark characterization is not supported by a similarly balanced examination of the history of the facility, which functioned until its closure in 2014.
There is no question that institutions like Fernald experienced serious problems, particularly in the early and mid-20th century. But the book gives virtually no attention to the landmark federal litigation in Massachusetts — Ricci v. Okin — which brought about significant improvements, starting in the 1970s, in the care and conditions at Fernald and other developmental centers in the state.
That omission is not a minor one. The Fernald Center remains a potent symbol in the ongoing debate over the future of care for people with intellectual and developmental disabilities (I/DD), including the role of the two remaining congregate care facilities in Massachusetts — the Wrentham Developmental Center and the Hogan Regional Center. By focusing almost exclusively on the Fernald Center’s darkest chapters, the book reinforces a one-sided narrative that continues to shape policy discussions today.
Green has long promoted uniformly negative views about Fernald, the institution. For a number of years, he organized protests and petitions related to the Fernald site, and wrote a commentary in November 2020 that advocated for deinstitutionalization. He was also instrumental in the creation of a state commission in Massachusetts, which made several uniformly negative statements about institutional care in its final report.
Green’s advocacy on these issues is also relevant in light of the book’s selection last month as the winner of the National Book Critics Circle Award in the biography category.
Book lauds Walter Fernald, but disparages the Fernald Center
Here is Green’s description of Walter Fernald, the man, in the introduction to his book:
When (Walter) Fernald died (in 1924)…(h)e was remembered for his compassion and kindness; for having seen a group of people who were otherwise unseen, as individual human beings deserving of our attention, love, and fellowship.
Green also states, later in the book, that:
No figure in American history did more to develop a link between the expert professions that continue to work with the cognitively and developmentally disabled today… Because of his influence on the world around him, (Walter) Fernald’s story is of immense historical significance, but its greatest importance lies in his capacity for self-reflection, self-criticism, and change.
Green does criticize Walter Fernald for his view that intellectual disabilities are inherited, and for being “a master propagandist (and) a moralist prude.” But that criticism pales in comparison to the assessments he makes about Fernald, the institution.
Here is the opening paragraph of the introduction to Green’s book:
The Walter E. Fernald State School is the most important historic site of its kind in the United States. The nation’s foremost institution for intellectually and developmentally disabled people, the school had a life span that stretched across an expanse of time from before the Civil War into the early twenty-first century. But for those who know its name, it does not stir thoughts of dates, places, or events. It is a threat, a nightmare, a deep-seated fear. It is a feeling. A place of shame. Its name is a provocation. It should be.
Here is the first sentence of the second paragraph of the introduction:
Sprawling across 196 acres near Boston, the Fernald School is synonymous with the scandal of human experimentation in the 1950s, of gut-wrenching exposes of abuse and neglect, of the futility of institutionalization and society’s widespread failure to confront that fact.
When it comes to Walter Fernald, Green can clearly be quite complimentary. But when it comes to the facility that Walter Fernald ran, he is relentlessly negative. The question is why. Why not treat Fernald, the institution, with the same open-mindedness and fairness that he treats Walter Fernald?
Fernald, the facility, lasted 90 years after Walter Fernald’s death. It was closed over the objections of the families of its 14 then remaining residents, who filed administrative and court appeals to keep it open. The appeals were ultimately unsuccessful.
Why leave out the positive aspects of Fernald’s history after the 1980s, long after Walter Fernald’s death?
The late U.S. District Court Judge Joseph Tauro noted in his 1993 disengagement order from the Ricci V. Okin case that both the major capital and staffing improvements to the facilities and a program of community placements had “taken people with mental retardation from the snake pit, human warehouse environment of two decades ago, to the point where Massachusetts now has a system of care and habilitation that is probably second to none anywhere in the world.”
Green doesn’t mention that. In fact, he dispenses with Tauro and the Ricci case with one sentence, simply saying that:
In Massachusetts, a series of suits on behalf of inmates, first launched by University of Massachusetts Professor Ben Ricci at the Belchertown State School, were consolidated by Judge Joseph Tauro in federal court, and when Michael Dukakis became governor in 1975, he committed to settling the combined suit by pumping significant sums of money into institutional reform.
Green does not acknowledge Tauro’s conclusion that the reform resulted in a world-class system of both institutional and community-based care. To do so would contradict the narrative that the Fernald Center was never anything other than a nightmare and a place of shame.
Governor asked about Wrentham and Hogan
At a March 27 appearance on Boston Public Radio’s Ask the Governor segment, co-host Jim Braude lauded Green’s book as Governor Maura Healey stood by. Later in the show, Healey took a question from Elaine Strug, a COFAR member and a member of our partner organization, The Saving Wrentham and Hogan Alliance.
Elaine asked whether Healey planned to keep the Wrentham and Hogan Centers open, noting that her son would benefit from the 24/7 specialized medical and clinical care available in either of those facilities. Elaine pointed out that Hogan and Wrentham, which are now known as Intermediate Care Facilities (ICFs), are federally regulated and Medicaid certified.
Healey responded to Elaine, saying, “Rest assured, there are no plans to close any facilities in Massachusetts.” But Elaine was not able to ask a follow-up question as to why individuals like her son are generally denied admission to the centers, and why the administration appears to be letting the centers die by attrition.
Little actual discussion of the Fernald Center
It is also somewhat strange that while Green’s book condemns the Fernald Center, it devotes relatively few of its 368 pages to actually discussing the Center’s sins and shortcomings.
The book instead dwells at length on Walter Fernald’s complex relationship with the eugenics movement in the U.S. and around the world in the early 20th century. Green also extensively discusses Fernald’s shifting views on the nascent intelligence testing movement during that same period. He notes that while Fernald understood the necessity of such testing, he questioned the methodology that was being developed at the time and whether it was accurate in measuring the capacity of persons with I/DD.
Green further discusses Fernald’s skepticism of the push in the early 20th century, in line with the eugenics movement, to sterilize people with I/DD. He quotes Fernald as saying that intellectual disability, which was then called feeble-mindedness “is infinitely a more complicated problem than the believers in the potency of sterilization would have us believe.”
Green’s discussion of those topics is the strongest and most interesting part of his book. There is actually remarkably little discussion in the book of conditions in the Fernald institution itself, even prior to the 1980s.
Green does acknowledge that by the time Fernald closed in 2014, the community-system itself wasn’t living up to the promise that had been envisioned for it. He states that, “group homes became isolating and isolated mini-institutions in and of themselves.”
Green also recognizes that by 2014, the parents of the remaining residents were resisting Fernald’s closure, noting that, “They had fought for improvements to the institution and were getting them. Why should they send people into a world (community system) of cruelty and abuse?”
But then Green dismisses the parents’ concerns:
They were unwittingly in the same position as Walter Fernald in the 1890s, making the argument that had failed him because it deprived disabled people of their fundamental rights as a result of something they were not responsible for – the cruelty of the nondisabled.
Green’s is the standard argument in favor of community-based care: Even if the community system is an isolating system consisting of isolated mini-institutions, disabled people have a right to be subjected to those conditions. Even their families need to understand that this is what is best for them.
And Green flatly states that “the institutions were capable of only so much reform. Rampant abuse was impossible to stamp out,” although he acknowledges abuse is “as likely to occur inside or outside of an institution.” So, why does he condemn only institutional care at the outset of the book?
A book that gets institutional care right
The best history of institutional care I’ve read is Ingrid Grenon’s book, “From One Century to the Next: A history of Wrentham State School and the Institutional Model in Massachusetts.”
As I noted in my review of Grenon’s book, her account of the Wrentham Center makes a powerful case that institutions, in themselves, are neither good nor bad. It is how they are run that counts, just as is the case in any care setting. Grenon recounts that the 1920s was a period when the then Wrentham State School, under the direction of its first superintendent, George Wallace, had a caring staff and administration, and offered a multitude of services and activities for the residents.
As Grenon points out, the Wrentham Center, like Fernald and other similar institutions that sprang up in this state and around the country, entered a long decline, starting in the 1930s as they became more and more overcrowded and understaffed. The state schools in Massachusetts were finally brought back to excellence as a result of the Ricci v. Okin class action litigation.
Unlike Green, Grenon, in our view, draws the correct lesson from history of the role of institutional care in Massachusetts and elsewhere around the country.
Former DDS official asks why an intellectually disabled man can’t get basic services
Ken Moran, a former assistant area director with the Department of Developmental Services (DDS), has been an advocate for Steven Voisine and for Steven’s mother Deborah for several years.
Now living in Florida, Moran still keeps in touch with them, and wants to know why Steven today can’t get the basic services he needs from the Department.
Steven, 37, once had an ideal living arrangement in an apartment with roommates in Lowell. But it all fell apart in 2020, after a DDS-funded corporate services provider allowed a known drug user and dealer to live in the residence.
The drug dealer, whose name was Nick, died of a drug overdose that year. But Ken, and Steven’s mother Deborah, said the provider, the Cooperative for Human Services (CHS), falsely blamed Steven for Nick’s problems; and Steven was forced to move out. Meanwhile, they said, Nick had been stealing Steven’s antipsychotic medications.
No longer getting services
Having lost what had initially been an ideal residential arrangement, Steven went on to live in an array of residential settings, Deborah and Ken said. He experienced temporary homelessness and received minimal case management.
Even though he is 37 years old, he moved into his current apartment in an elderly housing building in Gardner. Ken noted that there is no staff support for him during the day.
Although Steven is under the care of the DDS North Central Area Office in Fitchburg, “They (the area office) don’t know what to do with him or with their other clients,” Deborah maintains. “They just tell us they are overbooked.”
Ken said DDS has most recently offered to find a MassHealth-funded day habilitation program for Steven. But that’s not what he wants or needs.
“He needs someone to actually listen to him,” Ken said. “He needs an apartment with shared responsibilities. He needs someone to help him get his place in order.”
Steve and Deborah Voisine and their pets, Tom (left) and Oscar (right)
Ken noted that Steven “gets overwhelmed,” is obsessed with electronics, but has no concept of money. He is also unable to keep his apartment clean, and has no social activities or services.
Ken, who is also a former DDS group home licensure and certification inspector, recently retired as chief operating officer of Opportunity Works, a DDS day program provider.
Deborah has track record of accuracy
Ken maintained that Deborah has fought for years for adequate care and services for her son. “Debbie has been pooh-poohed by DDS for years,” he said. “But there is always truth in what she is saying.”
He maintained that Deborah has always tried to alert the Department and providers to potential problems with Steven’s care. One threat she noted was the admission of Nick to Steven’s shared living apartment.
Deborah said Steven had been happiest when living in the Lowell residence with two other DDS clients. Overnight staff stayed on the third floor of the building. There were 20 hours of staffing during the week. But when Nick was admitted, he brought in pot parties, drug addicts, and prostitutes, Deborah said. Ken said Nick had a history of drug abuse and arrests. His mother would bring pot to him.
Steven and Deborah believed Nick was stealing Steven’s medications to sell to drug dealers, so Deborah bought a lockbox for Steven to keep the medications in. They contended DDS knew Nick was a drug user, but still placed him in the apartment.
False accusation against Steven
One day in the fall of 2020, Ken, who had previously retired from DDS, drove Steven to Deborah’s house in Leominster for a weekend visit.
Steven brought his bag of clothes with him in a duffel bag. That Sunday, he called the manager of the shared apartment to ask if he could stay longer, and asked whether the staff could bring his medications to him.
Deborah said that when the manager went into Steven’s room to retrieve his lockbox, she found that the lockbox was gone. The manager called Steven to ask where it was, and he replied that he had left it on his dresser.
Deborah said the staff did a search of the entire building including the garbage and cellar. The lockbox was never found. But the staff nevertheless accused Steven of having taken the lockbox in order to place the blame on Nick for having taken his medications.
Ken and Deborah maintained that accusation against Steven wasn’t true. Steven subsequently had no antipsychotic medications for 10 days, and his psychiatrist wouldn’t prescribe any more.
Nick died of a drug overdose a few months later, in December 2020. Steven’s pill bottles found in Nick’s room when he died, Deborah said.
As noted, Steven was forced to move out of the residence. In our view, this amounted to an eviction by the provider. We think DDS should have informed Deborah of her right to challenge it.
What Steven needs
Ken and Deborah maintain that it wouldn’t be difficult or expensive to serve Steven properly. DDS would need to gain an understanding of his needs. As Ken explained, Steven needs the following services:
- Help managing money
- Help in keeping his apartment clean
- Assistance with hygiene
- Help in making friends
- Help in dealing with depression and weight gain
- Help in dealing with anxiety
- Help with medical and dental care
“He had this kind of support when he lived in Lowell,” Ken said. “He needs good roommates and some staff support. The right living situation could work for him.”
‘The forgotten children’
Deborah said there are many other DDS clients under the care of the North Central Area Office in Fitchburg, who are in the same situation as Steven. “We call them the forgotten children,” she said. She said she was told the service coordinators in the area are overwhelmed. Some have as many as 70 clients.
Both the director of the Area Office and the assistant director have left the office, and have not been replaced, she said. There is currently an acting director.
Deborah said she recently met with DDS Central West Regional Director Anthony Keane, who maintained that the only options for Steven are living by himself or in a group home. Neither option are suitable for Steven, Deborah said.
For the past several years, DDS has become increasingly unable to meet the needs of its clients. Long wait times for services are now the norm.
As we have said before, DDS has been contending with a shortage of staffing and resources, but has not attempted to make use of its existing assets such as the two remaining developmental centers or its state-run group home system. The Department routinely rejects requests for placements in its state-run residential facilities.
When basic services are unavailable for longtime DDS clients like Steven, and when terms like ‘forgotten children’ are used to describe them, it should be a wake-up call to the administration. Unfortunately, this administration appears content to muddle through, and is apparently not listening to many of its clients or aware of what their needs really are.
New report details ‘hidden costs’ in group home care for people with developmental disabilities
Is it really more costly per resident to operate state-run congregate care centers, such as the Wrentham and Hogan centers, than to operate group homes for people with intellectual and developmental disabilities (I/DD)?
That is one of the key assumptions behind decisions by a succession of administrations in this and other states to close state-run Intermediate Care Facilities (ICFs) and move the residents into privatized Home and Community Based Services (HCBS) settings.
But a new cost analysis of ICF versus HCBS group home care in Massachusetts supports previous calls by COFAR to reexamine that assumption. The report, “Hidden in Plain Sight: The True Cost of I/DD Services in Massachusetts and the Case for Restoring Choice,” was produced by COFAR’s partner organization, The Saving Wrentham and Hogan Alliance (The Alliance).
The report makes the overall point that the community-based group home system incurs an estimated $1.3 billion in taxpayer costs each year that are not included in the Department of Developmental Services (DDS) $3.3 billion budget.
COFAR made similar critiques a number of years ago of cost-comparisons issued by the then Patrick administrations to justify decisions to close the former Fernald Developmental Center and three other ICFs.
Today, Wrentham and Hogan are the only two remaining ICFs in Massachusetts, and we are concerned that the Healey administration is letting those facilities die by attrition.
The cost justification for closing the ICFs has been based on comparisons of two line items in the state budget: 1) the community-based residential line item (5920-2000), and 2) the ICF or state facilities line item (5930-1000). But while that analysis provides an accurate account of the cost of serving ICF residents, it is inaccurate as a basis for calculating the cost of serving clients in HCBS group homes.
As the Alliance report explains, ICF costs are bundled into a single rate, which is reflected in the ICF line item in the state budget each year. Those include staffing costs, clinical care, food, housing, and facility costs. All of those costs are included in the state-funded line item for Wrentham and Hogan. The full cost of care is visible in one place.
In contrast, the costs of serving people in group homes show up in several state and federal budgets, including MassHealth, Housing and Urban Development (HUD) subsidies and in SNAP benefits, in addition to the DDS community residential line item. So the argument by ICF opponents that those facilities are more expensive per client than group homes is flawed because only the DDS line item spending per resident is considered in each case.
The Alliance report points out that there are many areas in which spending on group homes occurs outside of the DDS community-based residential line item. A number of those “hidden costs” are calculated in the report, including the following:
- $411 million in day habilitation costs paid by MassHealth
- $385 million–$595 million in medical costs, and $28 million–$75 million in dental costs for adults with I/DD
- $53 million in SNAP benefits
- $33.6 million in transportation costs
- $750,000–$4.5 million in police response to group home crises
The Alliance also discussed a number of other structural reasons for higher-than-expected costs of residential care in HCBS settings, including the high salaries of the executives of corporate residential providers funded by DDS.
A 2022 COFAR survey found that between Fiscal Years 2012 and 2020, total compensation of CEOs, executive directors, and other corporate provider executives in Massachusetts rose from $102.4 million to $125.5 million. That is a 23% increase. Also, the survey found that the average compensation paid per executive rose from approximately $161,000 to $184,000 — a 14% increase.
The Alliance report also found that the HCBS system shifts costs for clinical, medical, and police behavioral responses to cities and towns. HCBS providers are not required to have on-site nursing or medical staff, behavioral crisis responders, or emergency response staff, all of which are provided by ICFs. Instead, the HCBS system relies on calling 911 and on local police, EMS and emergency rooms in hospitals and clinics.
This is why it is misleading to compare the ICF line item with the line item for group homes and divide by the number of residents. A valid comparison must include all major service components, including day habilitation and other supports funded outside the DDS community-based residential line item.
Comparing the DDS ICF budget to multiple budgets that affect group homes leads to the misleading conclusion that the cost of ICF care is higher per resident than group home care, when that isn’t necessarily the case. The Alliance report doesn’t dismiss the ICF costs; rather it says many group home costs are hidden in other budgets, which makes those costs less transparent.
Apples-to-apples cost comparisons are needed
The hidden costs that the Alliance report calculates, some of which COFAR has reported as well, may not prove ICFs are less expensive than HCBS group homes on a per-resident basis, but they effectively rebut the claim that closing ICFs saves money. Without a comprehensive, apples-to-apples analysis, claims of cost savings from closing ICFs are not adequately supported.
The Alliance report makes the reasonable and sensible recommendations to:
- Increase transparency across all funding streams supporting I/DD services, including MassHealth, SSA, HUD, USDA, municipal budgets, and development finance agencies.
- Restore access to state-operated ICF care as a choice for individuals with severe and profound disabilities. COFAR is proposing language in the Fiscal Year 2027 state budget stating that persons found to be eligible for ICF-level care have a right to that care in Massachusetts.
- Reinvest public funds to improve direct care wages, reduce turnover, and strengthen clinical supports.
- Conduct independent audits of HCBS provider finances, real estate holdings, and service delivery practices.
The report correctly concludes that:
Massachusetts’ I/DD service system is far more costly and fragmented than the public budget suggests. By acknowledging hidden costs, restoring balanced service options, and strengthening oversight, the commonwealth can better serve individuals with I/DD, support families, and ensure responsible stewardship of taxpayer dollars.
The Alliance report provides important new data rebutting the argument that state-run, ICF-level care is necessarily more expensive than privatized care.
Key contract documents appear to be missing in DDS guardianship arrangement
Key contract documents appear to be missing involving the procurement of a corporate guardian that has restricted the visitation rights of at least two clients of the Department of Developmental Services.
We have reviewed procurement documents involving TLC Trust, Inc., which has been under a 10-year contract with DDS since 2018 to provide guardianship services to DDS clients. Those documents raise several questions concerning the procurement process.
Neither DDS nor the state comptroller has produced or identified a Master Agreement between DDS and TLC Trust, despite a statement in a DDS guardianship bid solicitation in 2018 that qualified bidders would sign such an agreement.
The bid solicitation, known as a Request for Responses (RFR), also stated that a Procurement Management Team (PMT) would “evaluate proposals in detail and make recommendations for selection.” While DDS did provide the RFR and bid documents submitted in response to it by TLC Trust, DDS did not provide us with any documents reflecting an evaluation of TLC Trust’s bid, beyond a brief award determination.
We previously reported on family visitation restrictions affecting Naomy Alecia and Ryan Moran, two clients for whom TLC Trust has been serving as guardian. We have expressed concerns that those restrictions may be inconsistent with DDS regulations concerning visitation rights.
In December, we asked DDS in a public records request for all current contracts between DDS and TLC Trust. DDS provided only Page 1 of a 5-page Standard Contract Form with the nonprofit organization. That page contained no scope of services or terms and conditions for the provision of guardianship services.
We also asked DDS in January for all bid solicitations and evaluation documents relating to the selection of TLC Trust. As noted, DDS did not produce any evaluation documents.
Because DDS had produced only the first page of a Standard Contract Form, we filed a public records request with the state comptroller in February to find out whether the Comptroller’s Office might have the Master Agreement. On March 5, the Comptroller’s Office responded to our request, stating that it did not have any contractual documents between DDS and TLC Trust to provide guardianship services.
In reviewing the procurement materials that DDS did send us, we also noted the following:
- Of four resumes submitted by TLC Trust in response to the 2018 RFR, only one explicitly referenced guardianship activities, and one did not even reference TLC Trust. At the same time, TLC’s RFR submission stated that the organization had served as guardian to 65 individuals between 2012 and 2018.
- TLC’s RFR response stated that the organization “accompanies individuals for medical care.” In Ryan Moran’s case, his mother reported that TLC Trust has prohibited the family from attending medical appointments.
- The RFR stated that guardians receiving reimbursement under the contract must adhere to DDS’s Standards to Promote Dignity, which include provisions concerning visitation rights. As noted, the cases of Naomy Alecia and Ryan Moran have involved restrictions on family visitation that their families contend are inconsistent with those standards. This raises questions about how DDS monitors compliance with those requirements for guardians operating under the contract.
No answers to questions
On March 4, I emailed DDS Commissioner Sarah Peterson, asking the following questions:
1. Did DDS execute a Master Agreement with TLC Trust pursuant to the RFR? If so, where is that agreement kept?
2. Were detailed evaluation materials created of TLC Trust’s RFR submission? If so, can DDS confirm their existence?
3. Did DDS verify TLC Trust’s representation that it was serving as guardian to 65 individuals as of 2018?
4. Which TLC Trust employees have served as guardians of DDS clients since 2018, and what is the approximate client caseload per staff member?
5. How does DDS assess whether guardians receiving reimbursement under this contract are adhering to the Standards to Promote Dignity referenced in the RFR?
To date, I have not received a response from Peterson or the Department to my questions.
Lack of information raises further questions
A lack of answers and information from both DDS and TLC Trust only raises further questions and confusion about the organization’s role and qualifications.
In January, I emailed Gayle Greene, executive director of TLC Trust, and Diane Parker, who is listed as a case manager there. I noted that we were urging TLC Trust to ensure that their visitation policy conforms to the Department’s regulations, and we were asking that they re-examine and remove any visitation restrictions that have been placed on these two families. We believe these restrictions are causing stress and hardship to Naomy and Ryan and to their families.
I also asked how many DDS clients TLC Trust currently provides guardianship services for. We have reported that payments from DDS to TLC Trust from Fiscal Year 2022 through the current fiscal year have totaled $532,000. That averages out to close to $125,000 a year for the four full fiscal years from 2022 to 2025.
Both Greene and Parker are listed in court documents as performing guardianship services to Ryan Moran. Naomy’s mother, Lizvette Rivera, said Parker was providing guardianship services to Naomy. Neither Greene nor Parker responded to my January email query.
Despite the lack of mention of guardianship experience in most of the resumes submitted to DDS, TLC Trust stated in a one-page description of the organization’s history and qualifications that it started providing guardianship services to DDS clients in 2012, and was providing those services as of 2018 to 65 people. The one-page description added that:
Staffed by an Executive Director and three case managers (resumes attached), we consider ourselves “hands on” guardians. …DDS refers to TLC Trust on average between two and five new individuals per month for guardianship services. We have come to be known as an agency that will provide services to individuals who have dual diagnosis and whose situations could be described as “difficult”.
Given that only one of four resumes mentioned guardianship experience as of 2018, TLC Trust’s claim that it was providing those services to 65 people as of that year raises questions about the quality of those services and who was actually providing them.
We have urged DDS to investigate TLC Trust’s actions as guardian to Naomy and Ryan.
The RFR stated that DDS would reserve the right to remove any selected guardian if the guardian’s “conduct should fall below that expected of a fiduciary at the Department’s and the Court’s discretion.” In our view, in restricting family visitation, TLC Trust has displayed conduct that appears to fall below that expected of a fiduciary.
However, given that there is no complete contract that has been produced in this case, we don’t know whether such a contract contains a term similar to the RFR in which DDS reserves the same right to remove TLC Trust.
In an editorial today, The Boston Globe decried the state’s poor track record in responding promptly to public records requests, and in providing information to the public in general. As the Globe noted, “Well-managed public entities should certainly be able to respond to requests for information in a reasonable amount of time, at a reasonable, or no, cost.”
Unfortunately, there seems to be no better example, in our experience, of this disinterest in transparency in government than the Massachusetts Department of Developmental Services.