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Waltham group home reportedly temporarily shut down due to insect infestation
Five residents of a group home in Waltham for persons with intellectual and developmental disabilities were evacuated from the residence last week after it was ordered shut down due to an insect infestation, according to the mother of one of the residents.
Christine Davidson, whose son John is a resident of the home, which is run by WCI, Inc., a corporate provider to the Department of Developmental Services (DDS), said her son and the other residents have been temporarily moved into the Marriott Hotel in Woburn. She said it has been difficult to get information about the situation, and no one has told her when the group home will reopen.
Christine has previously raised concerns about what she contends are unhygienic conditions in the residence.
The insects appear to be cockroaches, based on a photo taken by Christine of her son’s BiPAP breathing machine, which appears to have two roaches inside it. Christine said that when John came home to her house over the weekend, she saw bugs in his breathing machine, and said two bugs crawled out of his wheelchair. BiPAP and CPAP machines are used to treat sleep apnea.
A portion of John’s breathing machine, which appears to contain two cockroaches. (Photo taken by Christine Davidson.)
It is unclear whether the group home was ordered shut after an inspection by DDS. The Department conducts licensure inspections of both provider-run and state-run group homes.
I sent an email Tuesday morning to DDS Commissioner Jane Ryder, asking whether the Department had any comment on the shutdown of the home, and whether the shutdown is an isolated incident. Ryder has not yet responded to my message.
Christine said the residents are being fed meals in their rooms in the hotel. She said John has been taken on a daily basis to his day program in Medford since his move to the hotel, but has few other activities while he is in his hotel room.
She said she is concerned her son’s health may be at risk as a result of the infestation. “Right now, he (John) doesn’t have a breathing machine,” she said. “It’s a dangerous situation.” She said the group home took back his contaminated machine.
Christine said she believes John could have picked up a pulmonary infection by using a machine that was infested with roaches. She said she has made several calls to her son’s DDS service coordinator and the coordinator’s supervisor hoping to relay her concerns and get answers to her questions, but no one has called her back.
Christine has previously raised concerns about unsanitary conditions at the Waltham group home, including the allegedly unhygienic state of John’s BiPAP breathing mask. On February 3, 2022, Steven Cohen, a gastroenterologist with Beth Israel Deaconess Medical Center, also stated in a medical progress note that John’s breathing mask at that time was “apparently not hygienic.”
Also last February, Christine sent us photos of potentially unsanitary conditions inside the group home, including a clogged air vent, a dirty bathroom, and what appeared to be insect larvae on John’s clothing in his bedroom dresser drawer. At the time, we were not able to confirm that the objects on his clothing were actually larvae.
Christine said that despite her complaints, the unhygienic conditions in the group home have persisted over the past year. It is unclear why those issues have lingered until they apparently triggered a shutdown of the residence.
We are receiving more frequent reports of a lack of activities and proper care of residents in group homes around the state. These reports appear to stem, at least in part, from an ongoing staffing shortage since the COVID pandemic began.
Continuing drop in number of residents threatens continued existence of DDS state-run facilities
New data that COFAR has received from the Department of Developmental Services (DDS) shows the number of residents or the census at both the Wrentham Developmental Center and Hogan Regional Center continued to drop from Fiscal Years 2019 through 2022.
The data, which was provided by DDS last week under a Public Records Law request, shows that as of Fiscal Year 2022, the census at the Wrentham Center was 182, down from a high of 323 in Fiscal 2013 — a 44% drop. The census at Hogan was down to 95 in 2022, from a high of 159 in 2011. That is a drop of 40%.
Previous data from DDS showed that the total census in the state-operated group homes declined from a high of 1,206 in Fiscal 2015, to 1,097 in 2021 — a 9% drop.
Meanwhile, the census in the state’s much larger network of privatized group homes has continued to climb, rising from 6,677 to 8,290 between 2008 and 2021 — a 24% increase. (See the graphs below.)
Hogan now has well under 100 residents remaining, and Wrentham is well under 200. Since August 2021, DDS has closed seven state-operated group homes and subsequently reopened one.
But more troubling than those closures is the fact that DDS does not inform individuals and families seeking residential placements that these state-run facilities even exist. Last fall, we wrote about a rare admission to the Wrentham Center, but that appears to have been the exception. We have heard from several people who have been unsuccessful in seeking placements for their loved ones in either ICFs or state-operated group homes.
That policy decision by DDS to discourage or block new admissions guarantees that the number of residents in state-run residential care will continue to drop, and that the ICF’s, in particular, will eventually be closed.
Source: DDS
DDS says it has no records on plans to close Wrentham or Hogan
Despite the continuing downward trend in the census at Wrentham and Hogan, DDS said in response last week to our Public Records request that they have no records concerning projections or plans to close those facilities. We have appealed that response to the state supervisor of public records, arguing that the Department did not indicate that it had done a search for such internal plans or projections.
Given the declining census at both Hogan and Wrentham, we believe it is unlikely that there are no departmental emails or other records at least discussing the possibility that these facilities will eventually close.
ICFs and state-operated group homes are vital backstops for care
State-run residential facilities are vital to the fabric of care in the DDS system. As Olmstead v. L.C., the landmark 1999 U.S. Supreme Court decision, recognized, there is a segment of the population with I/DD that cannot benefit from and does not desire community-based care. ICFs, in particular, must meet stringent federal standards for care that make them uniquely appropriate settings for persons with the most profound levels of disability and medical issues.
The ever-expanding network of group homes in Massachusetts that are run by corporate providers that contract with DDS have become bottom-line operations that meet minimal standards for direct-care pay and training. Abuse and neglect are rampant problems in the group home system. Meanwhile, the executives running these provider organizations have seen their salaries skyrocket in recent years.
As funding for the ICFs and state-operated group homes has declined or remained stagnant respectively over the past decade, funding for the corporate-run group home system has grown steadily to over $1.4 billion today.
Allowing the state-run network of care in Massachusetts to wither and die through underfunding and attrition will lead to a catastrophic decline in the level of care and services for some of our most vulnerable residents.
Mother says daughter’s health has declined at day program where she has few meaningful activities
At her day program in the Liberty Tree Mall in Danvers, Mia Cappuccio spends lots of time either walking around the mall with other clients, isolated from the community, or engaging in computer games and a handful of other repetitive and mundane activities, according to her mother Jeanne.
Jeanne said Mia has told her she has asked many times to participate in job training and internships at Parcels, a boutique in the mall. Parcels is run by the Northeast Arc, a corporate provider to the Department of Developmental Services (DDS). Northeast Arc runs both Mia’s day program and her group home.
According to Jeanne, Mia says the day program director repeatedly responds to her requests to work at Parcels by saying she will “‘look into it,'” but nothing ever comes of it.
Since Mia began attending the day program in October 2021, the staff have allowed her, over Jeanne’s objections, to buy candy and lemonade at the Five Below store there. Jeanne thinks the combination of Mia’s sugar intake and lack of exercise at the day program may have contributed to her development of diabetes, which was diagnosed in October.
Yet, Jeanne says, neither Northeast Arc nor DDS, which funds the provider agency, appear to recognize the problem.
Jeanne said she has requested that the day program staff help Mia to make better food choices, and provide Mia with activities other than making purchases in mall stores. But, she said, the day program management have responded that while they encourage Mia to make good choices, it is Mia’s “human right” to buy what she wants.
Jeanne said the day program management suggested that the solution to the problem is to take Mia’s debit card away from her or to suspend her participation in the program altogether. Jeanne maintains that neither of those suggestions are constructive because neither would provide Mia with cues for appropriate behaviors or with usable skills.
Mia and Jeanne Cappuccio
Mia’s day program is called STEP ( Skills Training Exploration Program), and is described on the Northeast Arc website as helping participants “build work and life skills.” But, Jeanne said, little or no such skill-or-work-related training is being provided to Mia in the program.
Mia, who is 26, has a moderate intellectual disability. She has lived in three group homes run by three different DDS providers; but Jeanne said that none of those settings have met her needs as required by DDS regulations.
We are hearing more and more from families and guardians that the COVID pandemic hastened a decline in overall care and services in the DDS community-based system. The decline has been marked by an ongoing staffing shortage. But Jeanne maintains the staffing shortage doesn’t fully explain the lack of meaningful activities provided by Mia’s day program.
Jeanne said Northeast Arc frequently extols its programs on social media and in podcasts. Recently, a Northeast Arc executive contended on a corporate podcast that the organization has helped more people with disabilities secure employment during the pandemic than in any previous year. “As I listen or read these things, I wonder – who does this apply to? Why isn’t this Mia’s reality?” Jeanne wrote to us.
Declining health
Jeanne said Mia’s mental and physical health have declined in the past several months. In addition to diabetes, Mia was diagnosed earlier this year with metabolic syndrome, a condition that can increase the risk of heart disease and stroke. She also developed fatty liver disease a year ago as well as narcolepsy.
Jeanne said Northeast Arc recently developed a behavior plan to address these issues; but she termed the plan “weak,” and said the staff are “woefully undertrained.” Also, she said, the plan has been implemented in Mia’s group home, but not at her day program.
Seeking self-directed model and requesting a change in placement
Earlier this year, Jeanne asked DDS officials whether the Department’s “self-directed services” model might work better for Mia than the traditional model of care under which DDS directly funds corporate providers to provide residential and day program services. Although DDS has been operating self-directed services programs since the late 1990s, the state Legislature authorized a major expansion of those programs in 2014 with passage of the “Real Lives” law.
Jeanne said provider and DDS officials met with her to discuss her self-directed services proposal, and recommended for the first time last month that she explore a shared-living arrangement for Mia. Jeanne said they told her the self-directed model could be made to work with shared-living services.
Jeanne said she and her husband Tom have agreed to explore the shared-living model, although she said Mia has said she would like to remain in a group home. Under the shared-living proposal, Mia would live in a home near her parents. A shared-living setting is run by an individual provider.
Jeanne said she and Tom also asked to explore another group home placement for Mia, particularly one that is state-operated. As we have reported, staff in state-run group homes and Intermediate Care Facilities in Massachusetts are better paid and better trained than their counterparts in the corporate provider-run group home system.
Jeanne said the response from DDS, though, has been that they typically refer only medically complex and highly clinically or behaviorally challenged individuals to state-operated facilities, and that those settings would not be an appropriate peer match for Mia. She added that DDS has also claimed residential placements are scarce, and there are no other residential placements in the Cappuccios’ community.
We disagree that state-operated placements are only appropriate for a restricted set of clients. In any case, it appears that Mia’s medical needs have become more acute in the past year.
Lack of exercise and concern over diet
Jeanne said that in August, when Mia’s gastroenterologist diagnosed Mia with fatty liver disease, he recommended a half-hour-a-day exercise program for her, five days a week, and a low fat diet.
To date, Jeanne said, Mia has no regular exercise program either at her day program or in her group home. She said staff maintain that they encourage Mia to exercise and eat healthy foods, but that they contend she is a picky eater and she refuses exercise.
In September, with Mia’s health issues unaddressed, a sleep specialist at Mass Eye and Ear determined that Mia was experiencing excessive daytime sleepiness and that she might have narcolepsy, Jeanne said. In late October, her primary care doctor stated that Mia’s condition had shifted from prediabetic to diabetic. The doctor’s notes stated that Mia’s group home was working on diet and exercise programs for her; but Jeanne said the group home has not been doing that.
Based on email correspondence between Jeanne and the day program staff, it doesn’t appear the staff have recognized the extent of Mia’s concerns. On November 4, a day program manager emailed Jeanne to say that Mia “has made a lot of progress and is doing really well. Mia has expressed on several occasions that she enjoys being in program and the activities that we provide.”
There was no acknowledgement in the program manager’s email of Mia’s health problems.
Three days later, Jeanne emailed the day program manager to say that medical lab results over the previous year had iindicated that there might be a correlation between Mia’s development of diabetes and her participation in the day program. In that email, Jeanne wrote that:
Mia has been purchasing candy, cookies and a liter of lemonade frequently at her day program. She has been experiencing fatigue and falling asleep often. It has been a vicious, unhealthy cycle. She needs support to manage her health, rather than her social behavior.
That same day, November 7, Jeanne brought the group home and day program situation to the attention of Kelly Lawless, the DDS northeast regional director. She wrote:
Direct care staff members have been quick to respond to correspondence and they appear to have good intentions. However, her programming has not met Mia’s needs and has resulted in a decline in her health and wellness. Her programming has substantially contributed to her development of metabolic syndrome, including diabetes.
Northeast Arc official contends the day program provides activites and exercise
In an email on November 21 to both DDS Commissioner Jane Ryder and to Northeast Arc CEO Jo An Simons, I asked for a response to Jeanne’s concerns about Mia’s day program and her request for a new placement for her.
Timothy Brown, chief innovation and strategy officer at Northeast Arc, responded with an email, stating that Mia had started in a class at her day program called “Health Matters,” and that she had “consistently made healthy eating choices” due to the class, and had not purchased any candy since her diabetes diagnosis.
Brown also contended that Mia has participated in “structured classes and programming that focus on employment goals and is exploring specific internship opportunities that were identified during these classes where she expressed career interests.” He didn’t identify those goals, and didn’t respond to a follow-up email seeking specifics about the internship opportunities and classes.
Brown also maintained that Mia has had “ample opportunities for physical exercise during the day.” He said those activities incude walking “alongside community members each morning prior to the mall opening”; day trip opportunities outside of the mall, and options during inclement wealther for Zumba and aerobics. He also said Mia attends the YMCA at least two times per week with her housemates, and uses an exercise bike on days she chooses not to go to the Y.
Exercise claims disputed
Jeanne, however, said in late November that she determined, based on Mia’s debit card transactions, that Mia has continued to go to pizza and barbeque wings restaurants in the mall at least once a week, and has continued to eat candy and sugary foods. She also said Mia told her that the instructor for the Health Matters class had been out for weeks and was out indefinitely. One of two of the provider’s care staff were taking turns running the class, she said.
Jeanne added that Mia told her the other activities in the day program primarily consist of computer games such as Jeopardy, Wheel of Fortune, and a game she has repeatedly played called Spent. A reviewer described Spent as a “harsh and often bleak” simulation of a situation in which the players are facing poverty and must figure out how to survive for 30 days on their last $1,000. “It is not appropriate or relevant and I don’t think it is intended to be played repetitively,” Jeanne told us.
Jeanne also said that, based on her review of the YMCA records, Mia has been to the Y 34 times in the past 11 months, which averages out to just over three times a month.
I have not received a response from Ryder to my November 21 email seeking her comment on the situation.
In our view, it is cases like this one that indicate whether a state agency such as DDS is effective in its management and oversight of its provider-run programs. When a provider can’t seem to recognize that a client in its care is experiencing severe health problems as a result of the policies and practices of that agency, the evidence begins to mount that the system is broken.
We would join with Jeanne in urging DDS to find a new and successful placement for Mia, preferably in a state-run facility. Given that Mia’s health is declining, DDS can’t afford to let the situation continue any longer.
Mother praises staff at the Wrentham Developmental Center after state grants her wish to have son placed there
When Janice Marinella first saw the Wrentham Developmental Center campus a few months ago, she had misgivings about whether it was the right place for her 34-year-old son Jeremy.
The red brick buildings on the sprawling rural campus are old, and some looked run-down. At the same time, though, she felt Wrentham was the last chance for Jeremy. He had been living in her home for the previous five years after his last group home closed unexpectedly.
In each of the three successive group homes in which he had lived, he had been either neglected or injured, Janice said.
Janice had to leave her career of 30 years in dentistry to care for her son at home. At first, it seemed like the right decision. But after five years, she felt she couldn’t continue to keep him at home due to the high level of care required. Yet she couldn’t find another safe or suitable residential placement for him.
“I felt that my own health and age were pressing down on me daily,” she said.
Janice Marinella and Jeremy.
But while the appearance of the buildings on the Wrentham campus made her decision to place her son there a difficult one, she soon came to reassess her initial reaction. She said she realized that what goes on inside the buildings at Wrentham is more important than how they look on the outside.
“I no longer see it (Wrentham) as institutional,” Janice said. “I now see the love and devotion the staff gives my son.” She added that even though the buildings are old, her son’s unit is “immaculate.
The hallways, the bathrooms are spotless,” she added. While many modern nursing homes smell of urine, she said, that isn’t true at Wrentham. “They really work hard to keep it clean.”
For Janice, the decision by the Department of Developmental Services (DDS) to admit Jeremy on September 20 to Wrentham has opened new and positive possibilities for both him and herself. It was a rare new admission to one of the two remaining developmental centers in the state.
“I’m so grateful that we have now found a real home for Jeremy,” Janice said. “My son deserves a home and family that will serve him after I am gone. This is the first time he has been treated with respect and dignity outside my care.”
Janice added that, “I see placing Jeremy here as an act of love for him. I want to love and support him through this transition, which I’ve made by choice and not due to an emergency.”
Welcomed by staff at Wrentham
Janice said placing Jeremy at Wrentham was “the hardest decision I’ve ever made. I had to learn how to trust again.”
She said the staff at Wrentham helped her to do that. “They were extremely welcoming,” she explained, adding that the staff appeared from the start to be trying their best to accommodate Jeremy’s needs.
And in what Janice said was a first for her, a member of the Wrentham staff told her that they saw “potential” in Jeremy. One member of the staff told her he was “honored” to be able to care for him.
“They have taken everything I express into consideration,” she said of the staff.
Facing a food and nutrition challenge
One of the first challenges the staff faced was to get Jeremy to adjust to the food at Wrentham. It has taken work and communication, Janice said, to ensure that Jeremy, who was used to her cooking, would continue to eat.
Jeremy, who weighed only 104 pounds when he arrived at Wrentham, and is 5-foot, three inches tall, needs to eat 3,000 to 4,000 calories a day, or he will lose weight, Janice said. He has a condition known as “failure to thrive,” which makes any weight loss dangerous to his health.
“The nutritionist, the social worker, the nurse – the whole team came down and talked to me,” she said. After two weeks at Wrentham, Jeremy’s weight actually went up, from 104 to 106 pounds.
Jeremy in his new room that the staff painted and Janice decorated, at the Wrentham Center.
Janice said when she told the staff that Jeremy does not generally engage in communal activities, but often likes to be by himself, the staff offered to make an unused room across the hall a sitting room available for him alone. He will be able to watch his TV set there.
The staff have been involved from the start, she noted, in making sure Jeremy has fulfilling activities. She said that during his first two weeks at Wrentham, they took him for walks, and took him in a van to an adult education program.
Jeremy also attended a fall festival on the campus, with lunch delivered outside. The staff provided Janice with a photo of Jeremy at the festival, holding a puppy on his lap. He will also attend the Center’s upcoming Halloween party.
“We are so excited to begin his swim program in the pool,” she added.
After a month of visiting Jeremy in his new home, Janice said she wants to work “to open the door to Wrentham to other parents.” Jeremy is apparently one of the first new placements at Wrentham in years. “I want to show others that this can work.”
“It’s such a blessing that they see potential in him,” she said.
Almost zero new placements at Wrentham in recent years
Developmental centers, also referred to as Intermediate Care Facilities for individuals with intellectual disabilities (ICF/IIDs), must meet more stringent federal requirements for care and conditions than do other residential facilities, such as group homes, in the DDS Home and Community Based Services (HCBS) system.
That has created a perception among policy makers that ICFs/IID are more expensive to operate than are group homes. However, it is not necessarily an accurate perception.
For the past several decades, ICFs/IID such as Wrentham and the Hogan Regional Center in Massachusetts have bucked a nationwide, ideological trend toward the closure of congregate care facilities. Starting in 2008, the administration of then Governor Deval Patrick closed four of the six remaining developmental centers in Massachusetts.
Since Fiscal Year 2012, as the ICFs/IID have been closed, the developmental center line item in the Massachusetts budget has shrunk by $78 million, or 42%, while the privatized group home line item has risen by $563 million, to over $1.4 billion.
That increase in the corporate provider line item appears to belie the promise that closing the developmental centers would save state taxpayers tens of millions of dollars in caring for persons with developmental disabilities.
As we reported last year, the Baker administration has largely declined to offer the Wrentham or Hogan Centers as options for people seeking residential placements in the DDS system in Massachusetts.
From 2018 to 2020, DDS documents state, the residential population or census at the Wrentham Center declined from 248 to 205, while admissions to the Center declined from only two in 2019, to zero in 2020.
The Patrick and Baker administrations and other opponents of ICFs/IID have also argued that the centers segregate clients from the wider community. But we have long maintained that that claim lacks evidence to support it.
The Wrentham Center, in fact, feels like a community, according to many family members and guardians of the residents there. The campus provides an array of centrally located services that cannot be found in any community-based group home in the commonwealth. Even so, Janice maintains the Wrentham Center doesn’t have an institutional feel to it. The campus has a mix of larger residential buildings and smaller, multi-bedroom homes.
Jeremy holds a puppy at the Wrentham Center fall festival.
Janice said that when she took Jeremy out for a walk on the campus on Tuesday (October 11), “I cannot even tell you how many folks said hello to us, slowed down and waved while passing, smiling, so happy to see us. I am overwhelmed by it. Every time I have gone to Jeremy’s unit, multiple people have come to say hello and discuss how Jeremy is doing and to express their happiness that he is in their care.”
Community-based system did not work for Jeremy
Prior to moving back home with Janice in 2017, Jeremy had lived in two provider–operated and then one state-operated group home. Janice said he was neglected and suffered serious injuries in those residences in a number of instances.
After Jeremy’s state-operated home in Dartmouth was suddenly closed in 2017, Janice decided he needed to live at home with her. She agreed at that time to voluntarily transfer her guardianship of her son to her ex-husband, Ed, so that she could be paid as her son’s caregiver. She said Ed was supportive of her efforts to care for Jeremy and, in the past year, to find a new placement for him.
But the search for a new placement was frustrating. Janice said she was continually told by DDS that there were no residential settings available in the Department’s New Bedford district, where she lives.
She said that after she contacted COFAR in March of this year, Colleen Lutkevich, COFAR’s former executive director, worked with DDS officials to arrange a tour of the Wrentham Center for her and Jeremy, and to gain approval for Jeremy’s admission there. Colleen’s sister Jean has lived at Wrentham for more than 60 years.
Wrentham needs to become a choice
Janice believes the Wrentham Center could and should become a residential option for more people with disabilities. She said she would be happy to talk with other family members or guardians about the facility.
“My son was warehoused in group homes,” she said. “At Wrentham, it’s about the staff and the opportunities. This is where he (Jeremy) was meant to be.”
In establishing state commission on institutional care, Legislature ignored committee-approved language proposed by COFAR
(COFAR Intern Joseph Sziabowski contributed to the research for this post.)
In July, the state Legislature approved the Fiscal Year 2023 budget with an amendment to establish a state commission to study the history of the former Fernald Developmental Center and other institutions in Massachusetts for persons with developmental disabilities and mental illness.
The budget amendment did not contain language proposed last year by COFAR, which would have helped ensure that the commission would not be biased against institutional care for persons with developmental disabilities.
We had expressed concern that the commission, as conceived in previously drafted bills (S.1257, and H.2090), might be used to call for the closure of the Wrentham and Developmental Center and Hogan Regional Center.
As we have reported, key proponents of the commission have promoted the closures of state-run residential care facilities, and have tried to focus public attention solely on the darkest periods of institutional care in this and other states prior to the 1980s.
The commission proponents have declined to acknowledge major improvements since the 1980s in care and conditions in the state’s developmental centers or Intermediate Care Facilities (ICFs). Those improvements were implemented largely due to the intervention of the late U.S. District Court Judge Joseph L. Tauro.
Committee redraft included COFAR language
However, even after the budget amendment was approved in the Senate in May, at least some of the language COFAR had proposed was included in a redraft of one of the original bills.
The redrafted bill (H. 4961), which was approved on June 30 by the Mental Health, Substance Use and Recovery Committee, would give COFAR standing along with other named advocacy organizations to appoint some of the commission members. Each advocacy organization, including the Arc of Massachusetts, would have one appointment.
The redrafted bill also contained our suggested requirement that the commission study the wellbeing of current residents of the Wrentham and Hogan Centers. The previous versions of the legislation included requirements to study the wellbeing only of former state facility residents now living in the community.
We had opposed those previous versions of the commission bill because the versions would preclude assessments of care of current residents of Wrentham and Hogan. We think many, if not most, of those assessments would be likely to be positive.
The Senate budget amendment contains no directives for the study of the wellbeing of either former or current residents of state facilities.
COFAR language superseded
But while the redrafted bill was sent on July 11 to the Health Care Financing Committee, it never emerged from that committee. It has been superseded by the budget amendment, which does not include any of COFAR’s proposed language.
The budget amendment does specify that one current resident and one family member of both the Wrentham and Hogan Centers will be eligible to serve on the commission. The previous bills did not provide for seats for current residents of the facilities or their family members.
However, the budget amendment gives the governor, and not COFAR, the authorization to appoint those Wrentham and Hogan members to the commission. In contrast, the amendment gives three anti-institutional organizations, including the Arc of Massachusetts, the authority to make one commission appointment each.
The budget amendment was bundled with hundreds of other amendments and approved on a voice vote in the Senate in May. As such, the amendment was not subject to a hearing or debate in the Legislature.
The Mental Health Committee’s subsequent redraft with some of our suggested language remains stuck in the committee. As a result, our concerns about possible bias in the commission remain.
Questions remain about the planned commission and its funding
Thus far, we haven’t been able to get answers to some key questions about the planned commission:
- There appears to be no clear indication when the commission will begin working, or how people can apply to serve on it.
- While the budget amendment earmarks $145,000 in funding for the commission, there appears to be no indication what the funding will be used for. The amendment doesn’t specify any staff for the commission, for instance.
- The budget amendment says the commission may study “the independent living movement,” but does not define that movement.
We have made repeated attempts to contact the sponsors of the commission legislation, other key lawmakers, and the governor’s office, which will make many of the appointments to the commission.
Only Representative Sean Garballey, the sponsor of the original House bill to create the commission, got back to us. In a phone call on August 26, Garballey said no decision had yet been made on when the commission will begin operating or when the appointments will be made to it. He suggested the appointment process could take several months, and might be delayed until the next administration.
Garballey suggested that persons who want to serve on the commission send letters to the Office of Governor Charlie Baker and, if necessary, whomever occupies the office after him. The letters should reference the relevant statute (Chapter 126 of the Acts of 2022, section 144) and articulate the constituent’s case to be on the commission.
Garballey said he was open to receiving recommendations or requests, from persons willing to serve on the commission, that he could pass along to the relevant appointing entities.
Asked about the purpose of the commission funding, Garballey said the money will be spent “at the discretion of the commission and its voting process.” He said he didn’t know with certainty what the funding will be used for.
Garballey said it was his “vision for the commission to tell the whole story,” or the entire history of the state institutions, dating back to the 19th century and moving ahead to the more recent positive reforms.
“I’m looking for a factual history, not one with political bias,” Garballey said. “I would be opposed to any effort to push a certain view or co-opt the commission to shut down any institution,” he said. “I would be appalled and disappointed if the commission was utilized in that way.”
We hope Representative Garballey’s vision regarding the commission prevails. But to ensure that is the case, we hope that the Legislature will amend the now statutory language establishing the commission to incorporate our suggestions. We also would like to see a directive added to the language that specifies that the commission will include the reforms of the 1980s in its historical analysis.
Our updated DDS corporate provider survey: Total number of providers in MA has dropped, but total executive comp. rises to $126 million
(Research contributed by COFAR Intern Joseph Sziabowski)
Seven years after we published our first survey of the financial compensation of executives employed by corporate providers to the Department of Developmental Services (DDS), our updated survey shows some surprising and not-so-surprising changes.
What might not be surprising is that between Fiscal Years 2012 and 2020, total compensation of CEOs, executive directors, and other DDS provider executives doing business in Massachusetts rose from $102.4 million to $125.5 million. That is a 23% increase.
Also, the average compensation paid per executive rose from approximately $161,000 to $184,000 — a 14% increase.
This trend remained constant across almost all executive categories. Nominal and inflation-adjusted average compensation rose for virtually all executive positions.
(Click to enlarge the summary chart below of total and average compensation of DDS corporate provider executives in Fiscal 2020.)
(You can find our full survey results at DDS Corporate Provider Compensation Survey)
What seems surprising in our updated survey is that despite the increase in total executive compensation between Fiscal 2012 and 2020, the total number of corporate providers actually declined by almost half in those years. Lists of all DDS providers were obtained from DDS in 2014 and again this year under Public Records requests.
Our surveys involved examining the federal nonprofit tax returns (IRS Form 990) of the listed providers for the 2012 and 2020 fiscal years. (Form 990 tax returns for all nonprofits are available at ProPublica and on other sites).
In our latest survey, we also cross-checked data with Massachusetts online Uniform Financial Reports (UFRs) for 149 DDS-funded, corporate providers.
In filling out the IRS Form 990, nonprofit organizations are required to list total compensation of “officers, directors, trustees, key employees, and highest compensated employees.” Key employees must earn over $150,000 and meet a responsibility test, while highest compensated employees are employees other than key employees who earn over $100,000.
The primarily nonprofit corporate providers funded by DDS in Massachusetts provide a range of residential, day program, and other services in the DDS system. While some of these providers do business in other states as well as in Massachusetts, DDS pays more than $1.4 billion per year to the providers to run a network of hundreds of group homes in this state alone.
State responsible for paying approximately 70% of executive compensation
By COFAR’s estimates, the State of Massachusetts was responsible for paying up to $87.8 million of the total $125.5 million in compensation received by the provider executives in Fiscal 2020. (An explanation of our methodology for calculating state reimbursement of executive compensation is below.)
Transfer of assets from public to private ownership
We also found that as of the end of Fiscal Year 2020, the providers held more than $3.82 billion in total assets. During that year, those providers received $5.64 billion in total revenues from public and private sources in Massachusetts and other states.
Assets range from buildings to vehicles to cash reserves, which have largely been acquired by the providers through their use of taxpayer revenues. As such, the assets held by the providers represent a “troubling transfer of that wealth from public to private ownership,” said COFAR President Thomas J. Frain. “We as taxpayers largely paid for those assets, but we’re never getting them back.”
Executive compensation vastly outpaces direct-care wages
The continuing increases in compensation of the provider executives stand in sharp contrast to largely stagnant wages that have been paid to direct-care personnel employed by the providers over the past several years.
It was only on July 28 that Governor Baker signed the state’s Fiscal 2023 budget, which contains a first-ever provision requiring all corporate human services providers receiving state funding under a special reserve account to direct at least 75% of that funding to compensation for direct-care and front-line staff.
There has been scarce information available, however, as to how much the budget provision will raise direct-care wages, and when the additional funding for those increases will be made available.
Frain said he is not persuaded that the new funding will do much to decrease the size of the gap between executive and direct-care wages. Direct-care wages have averaged around $16 an hour in Massachusetts. “The corporate provider service model allows the executives to siphon off large amounts of money that never make it to the direct-care workers,” he said.
Number of providers declined, but total compensation increased
Apparently due to consolidations and mergers, the total number of providers contracting with DDS to provide residential and day program services dropped from 298 to 160 — a drop of 46% — between Fiscal 2012 and the present. (Our numbers are based on the sizes of the two provider lists obtained from DDS in 2014 and this year.)
The apparent reason for the total increase in executive compensation in the period from Fiscal 2012 to 2020 is that there are actually more executives working for fewer providers today than in 2012. The number of vice presidents, in particular, rose from 100 to 162, between Fiscal 2012 and 2020.
As a result, the total number of executives rose to 682 in Fiscal 2020, compared to 635 in Fiscal 2012, according to information contained in the IRS 990 forms we examined.
In other words, the mergers and consolidations among the provider organizations do not appear to have reduced the layer of executive bureaucracy that existed in the provider system in Fiscal 2012. That layer has only grown thicker.
This may be one of the reasons that the promise of taxpayer savings in privatizing DDS services has not been realized.
The latest COFAR survey examined the compensation of 98 CEOs and presidents, 71 executive directors, 79 CFOs, 40 COOs, 162 vice presidents, and 232 other executivess, all earning average salaries of over $100,000.
Other updated survey findings include the following:
- The average CEO compensation was $263,189 in Fiscal 2020, up from $210,227 in 2012. The average executive director compensation was $163,375, up from $130,835 in 2012.
- The highest paid president received $903,135 in compensation from The Seven Hills Foundation in Fiscal 2020. In addition, the president’s spouse, listed as the executive VP/CEO, received $391,798 from that organization in Fiscal 2020. Together, the couple received $1.3 million in compensation from Seven Hills.
- The former CEO of the Devereux Foundation stepped down from that position effective January 1, 2018, but continued to work for the organization. That official received $913,124 in Fiscal 2019 and $683,159 in Fiscal 2020 while averaging only 20 hours per week in the latter year, according to the organization’s IRS tax forms. In Fiscal 2020, the former and current CEO of Devereux received a combined $1.4 million in compensation.
(Click on chart below to enlarge.)
Our methodology for calculating state reimbursement of provider executives
State regulations (808 CMR 1.05 (24) Salaries of Officers and Managers) limit state reimbursements to providers for the cost of compensating their executives. Limited executive compensation data for each provider and allowable reimbursement by the state are included in online UFRs.
For fiscal Year 2020, the UFR Auditor’s Compliance Supplement established a cap on state reimbursement for executive compensation at $187,112. For any executive receiving compensation greater than the cap, that excess amount must come from sources other than the State of Massachusetts, according to the regulations.
The Compliance Supplement also states that state reimbursements of executive compensation must be prorated if human service executives devote less than full time to state programs.
The UFRs submitted by the providers, however, do not appear to clearly show the total amounts of compensation received by all executives working for those providers, or how much of that compensation is actually subject to reimbursement by the state.
OSD did not respond to a request from COFAR to clarify the Compliance Supplement methodology for calculating and prorating state reimbursements of executive compensation.
Based on the guidelines, we did our own calculations of the total state reimbursement due for each provider executive. Operating under an assumption that providers receiving a portion of their funding from out-of-state governments were not devoting full time to Massachusetts programs, we also calculated a prorated reimbursement for those providers. (See the Proration Rates tab in our full spreadsheet for our proration calculations).
We hope that by continuing to bring the issue of executive compensation to light via our periodic surveys, we can persuade the administration and Legislature to take steps to better oversee and limit that compensation.
We think the fact that total compensation paid to DDS provider executives has continued to rise even though the number of providers has dropped is one sign that the provider system is not subject to adequate financial management and oversight.
We’ve been in a nine month battle with DDS to view 8 emails about closures of state-operated group homes
Last week, we filed the second of two appeals with the state Public Records Division for eight internal emails from the Department of Developmental Services (DDS) that may concern plans to close or consolidate state-operated group homes.
After two months of negotiations with DDS last fall, we had narrowed our Public Records request to just those eight emails. But following the negotiations, DDS simply declined in December to provide them, contending they are exempt from disclosure under the state’s Public Records Law.
As of the filing of our second appeal last week, our battle with the Department for records concerning its state-operated group home policies had stretched to nearly nine months.
In denying our request for the eight emails in December, DDS cited what is known as “Exemption d” to the Public Records Law, which says that a state agency can decline to disclose internal records “relating to policy positions being developed by the agency.”
As I’ll explain further below, we have countered that Exemption d does not apply in this case because the policy in question was adopted by the administration last August, and was no longer being developed when we requested the emails. We have suggested that the state Public Records Supervisor Rebecca Murray inspect the emails herself to determine whether Exemption d does or does not apply to them.
We’ve been concerned about the future of the state-operated group home network for years. While those homes are likely to recieve a nominal increase in state funding in the coming fiscal year, it is clear that DDS has been allowing the number of residents in the state-operated group home network to drop in the past several years. Yet the Department has not provided any public information about its intentions regarding the future of the state-run residental system.
State-operated group home network facing unique pressures
We view the state-run group home system as as a crucial backstop for care in the DDS system as a whole. Staff in the state-run network generally receive higher pay and benefits and more training than their counterparts in the corporate provider system.
Yet the state-operated system has been facing unique pressures, particularly since the start of the COVID crisis. Last October, we received a report from a COFAR member that up to seven state-run homes in the southeastern region of the state had been closed because staff in them had not been vaccinated for COVID.
Just weeks prior to that – in August — Governor Baker issued an executive order requiring all state employees to be vaccinated by October 17 or ultimately be terminated. That vaccination mandate applies only to staff of state-run residential facilities. It does not apply to the much larger network of DDS-funded group homes that are run by corporate providers.
Baker administration would not provide information
We initially emailed DDS Commissioner Jane Ryder and the press office at the Executive Office of Health and Human Services (EOHHS) on October 14 with questions about the reports of closures and consolidations in the state-operated group home network.
Ryder never responded to our query. A spokesperson for EOHHS said in a response to our email that we would have to file a Public Records Request for that information.
Records request narrowed from more than 1,000 emails to just 8
Based on the EOHHS response, we filed a Public Records request with DDS on October 15 for internal records that concerned closures or consolidations of DDS state-operated group homes due to unvaccinated staff or for other reasons.
In an initial response to our request on October 29, DDS stated that there were potentially 1,600 emails responsive to our request, and that producing the documents would require us to pay a $1,000 fee.
We agreed to narrow our request. And in a December 13 written response to us, a DDS attorney said the narrowed search had turned up a total of eight emails that were determined to be responsive to our request.
DDS cites “implementation of” the governor’s executive vaccination order as an “ongoing and evolving” policy
But despite identifying the eight emails as responsive, the DDS attorney stated in the December response that all eight of those emails were being withheld because they fell under Exemption d to the Public Records Law.
The attorney described the “implementation” of the governor’s vaccination order as “an ongoing and evolving policy matter.”
Renewed request for the 8 emails
In May of this year, after an initial appeal that did not result in the production of any additional documents by DDS, we tried again. We renewed our request for just the eight emails with the intention of appealing for a second time if DDS once again cited Exemption d. That is, in fact, what happened.
In a June 13 response, the DDS attorney stated that the “implementation” of the governor’s executive order was “still an ongoing and evolving policy matter which is still subject to the deliberative exemption.”
This time, the DDS attorney stated that:
While the governor’s executive order was implemented on August 19, 2021, ongoing and evolving policy matters continue related to the Agency’s implementation of the Executive Order, and the deliberative exemption applies to those policy decisions.
The DDS attorney added that the governor’s executive order had:
…impacted the discussion about and process of handling staffing shortages at DDS. The vaccine policy is still impacting the Department’s staffing shortage. Therefore, the records are still exempt under (Exemption d). (My emphasis)
DDS conflates policy implementation with policy development
In our second appeal of DDS’s response — which we filed on June 23 — we argued that the Department was “conflating the separate steps of policy development and policy implementation.” We noted that Exemption d refers to policy positions “being developed” by an agency. The exemption does not say that records relating to policy positions that are “being implemented” are exempt from disclosure.
We pointed out that public policies or policy positions are normally implemented after they have been developed or formulated. The implementation of policies can go on for years or decades or more. As we put it:
Certainly, the intent of “Exemption d” was not to allow agencies to assert that so long as policies are continuing to be implemented, all records concerning those policies remain exempt from disclosure.
We added:
As of June 23, now more than 10 months after the governor signed Executive Order 595, (DDS) says the policy is “still impacting the Department’s staffing shortage,” and has “impacted the discussion about and process of handling staffing shortages at DDS.” Here again, (DDS) appears to be talking about problems or issues the Department is having in implementing the executive order.
Finally, we suggested that the Public Records Supervisor review the eight emails in-camera to determine whether or not Exemption d does or does not apply to them.
In sum, we don’t know what is in the eight emails or whether the emails might shed any light on DDS’s plans for the future of the state-operated group home network. But given the administration’s unwillingness to provide any public information about those plans, all we can do is to fight for documents that are legally available and that might disclose the administraton’s intentions.
The fact that DDS is fighting back so hard to prevent the release of just those eight emails leads us to believe we may be onto something in seeking their release.
Senate budget amendment for commission on history of state schools continues to raise concerns of bias against state care
In what appears to be an end run around the legislative committee process, the state Senate last month approved an amendment to state budget legislation that would establish a state commission to study the history of institutional care of persons with developmental and other cognitive disabilities.
But as is the case with proposed legislation still in committee to establish the commission, the Senate amendment does not make it clear that the proposed commission would acknowledge major improvements since the 1980s in care and conditions in the state’s developmental centers or Intermediate Care Facilities (ICFs).
We have previously raised concerns about the legislation to establish the commission (S.1257, H.2090), which has been in the committee process for more than a year.
Given that the House did not adopt a similar budget provision to establish the commission, the proposal will be subject to a House-Senate conference committee that is currently meeting on the Fiscal Year 2023 state budget.
The Senate budget amendment addresses some concerns we previously raised about the proposed commission legislation, including language that indicates a bias against the state’s two remaining developmental centers – the Wrentham Developmental Center and the Hogan Regional Center in Danvers.
We do support efforts to study the history of the former state schools in Massachusetts for persons with developmental disabilities. Toward that end, we support proposed legislation to open up all historical state records to public inspection (S.2009, H.3150). But we want to ensure that the proposed commission considers the full history of these institutions, not just the darkest parts of that history prior to the 1980s.
Our concern is that proponents of further deinstitutionalizaton and privatization in the Department of Developmental Services (DDS) system could use the commission to call for the closures of the Wrentham and Hogan centers, and potentally other state-run residential facilities.
As we have pointed out many times, Wrentham and Hogan today provide state-of-the-art care, and are closely tied to their surrounding communities.
Budget amendment would provide four seats for residents and family members at Wrentham and Hogan
In one major improvement over the proposed legislation in committee, the Senate budget amendment would give residents and family members of the Hogan and Wrentham centers four out of what appear to be 16 seats on the commission.
But even in the Senate amendment, the makeup of the commission appears to still be largely dominated by opponents of the ICFs.
Also troubling is that pro-deinstitutionalization organizations such as the Arc of Massachusetts would specifically appoint at least three members of the commission. Meanwhile, the Hogan and Wrentham members would be appointed by the governor, who has also been a supporter of deinstitutionalization and the privatization of public services.
Commission proponent’s op-ed focuses on dark and early period of Fernald Center’s history
It is also troubling that some key proponents of the commission have continued to publicly express largely negative views of the history of the state schools without mentioning the significant upgrades that occurred starting in the 1980s in those institutions.
In discussing the Senate budget amendment in an op-ed in The Boston Globe on June 7, Alex Green, a major proponent of the commission, focused on the darkest years in the history of the state facilities in Massachusetts. Green specifically noted the connection of the former Fernald Center, in particular, to the eugenics movement in the late 19th and early 20th centuries.
Eugenics has been correctly characterized as a “scientifically erroneous and immoral theory of ‘racial improvement’ and ‘planned breeding.'” It gained popularity during the early 20th century.
In protests Green has organized against Fernald, and in petitions to Waltham Mayor Jeanette McCarthy, Green has similarly focused exclusively on human rights abuses at Fernald in the first half of the 20th century. The Arc and other advocacy organizations have signed on to those petitions.
The early history of Fernald and the other state schools in Massachusetts is certainly a deeply troubling one. And the man for whom the institution was later named — Walter E. Fernald — was initially an active proponent of eugenics laws that were being adopted in the late 19th and early 20th centuries in the U.S.
But by the 1920s, even Walter Fernald had come to reject the principles of eugenics, and “became a supporter of community placement…” for persons with developmental disabilities, according to the Encyclopedia Britannica.
The commission legislation does not specify that the commission would examine the history of Fernald subsequent to Judge Tauro’s involvement
We have repeatedly objected to the commission legislation on the grounds that it doesn’t specify that the commission would consider the full history of the state schools.
The improvements at Fernald and the other institutions were undertaken as a result of the intervention of the late U.S. District Court Judge Joseph L. Tauro. Tauro noted those improvements when he disengaged from his oversight of a landmark consent decree case in 1993. He wrote that the improvements 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.”
The Senate budget amendment provides little specificity as to the historical focus of the commission. It does, however, contain this fairly convoluted sentence, which raises a number of questions about the commission’s focus. The sentence states that the commission will:
…design a framework for public recognition of the commonwealth’s guardianship of residents with disabilities throughout history, which may include, but shall not be limited to, recommendations for memorialization and public education on the history and current state of the independent living movement, deinstitutionalization and the inclusion of people with disabilities. (my emphasis)
Given the commission will be largely dominated by organizations in favor of deinstitutionalization, we are concerned any such study of that issue may be biased.
It is also curious that the history and current state of the independent living movement and deinstitutionalization would be included in the commission’s charge, given the subject of the commission is the history of state institutions.
The Senate amendment doesn’t define the “independent living movement.” Also, a complete study of just deinstitutionalization would take the effort of a separate commission in itself.
In addition, we think it is unwise for the budget conference committee to adopt the commission idea as a budget provision. This is an idea that needs to work its way through the checks and balances of the committee process.
As part of that committee process, the concerns we’ve raised about the makeup and possible bias of the commission still need to be addressed. At the least, we think language should be added to the proposed legislation stating that the commission will examine the complete history of the state’s institutional facilities.
The full history of the state institutions for persons with cognitve disabilities in Massachusetts starts with the founding of those facilities, and it continues to the present day.
State budget language mistakenly implies Supreme Court ordered closures of institutions for persons with developmental disabilities
COFAR is urging state legislative leaders to correct language in state budget legislation that mistakenly implies that the U.S. Supreme Court ordered the closures of institutions for persons with developmental disabilities.
The language in a budget line item cites Olmstead v. L.C., the Supreme Court’s landmark 1999 decision, which considered a petition by two residents of an institution in Georgia to be moved to community-based care. The Olmstead decision has been frequently mischaracterized as requiring the closure of all remaining state-run congregate care facilities in the country.
According to this characterization, Olmstead further required that all residents of those facilities, which include Intermediate Care Facilities (ICFs), be transferred to community-based group homes.
In one of three instances in which COFAR is seeking changes or corrections, the Massachusetts budget line item language states that the Department of Developmental Services (DDS) must report as of December 15 to the House and Senate Ways and Means Committees on “all efforts to comply with …Olmstead…and… the steps taken to consolidate or close an ICF…” (my emphasis)
However, in letters sent last week to the chairs of the House and Senate Ways and Means Committtees, COFAR noted that closing institutions was not the intent of the Olmstead decision, which was written by the late Justice Ruth Bader Ginsburg.
As our national affiliate, the VOR, has pointed out, “the Court’s determination in Olmstead supports both the right to an inclusive environment and the right to institutional care, based on the need and desires of the individual.” (my emphasis)
We are concerned that the misstatements in the ICF line item in the state budget each year could allow the administration and Legislature to justify continuing to underfund the line item, and possibly to seek the eventual closures of all remaining ICFs in Massachusetts. Those ICFs consist of the Wrentham and Hogan Developmental Centers, and three state-run group homes on the campus of the former Templeton Developmental Center.
The problematic language in line item 5930-1000 is included in both the House and Senate Ways and Means Committee versions of the budget for Fiscal Year 2023, which begins on July 1.
Declining funding in line item tracks budget language history
COFAR first identified the budget line item language last year, and reported that the language appears to have been included in the line item in state budgets going back as far as Fiscal Year 2012.
It is perhaps not coincidental that since Fiscal Year 2012, four of six remaining developmental centers in the state have been closed. And when the Fiscal Year 2023 budget is adopted, the ICF line item will have been cut since Fiscal 2012 by $78.2 million, or 42%, when adjusted for inflation. (Those numbers are based on the Massachusetts Budget and Policy Center’s Budget Browser app.)
Three of the DDS reports required by the line item language — for calendar years 2018, 2019, and 2020 — discussed a steadily dropping population or census at the Wrentham and Hogan centers, and practically zero admissions to those facilities after 2019 as well.
We have noted that the lack of admissions to Wrentham and Hogan indicate that the administration is unlawfully failing to offer those settings as residential options to indivdiuals with developmental disabilities who are seeking residential placements in the state.
Three mistaken or misleading statements
There are what appear to be at least three mistaken or misleading statements in the language in line item 5930-1000: (The first item below is simply a case of wrong terminology.)
1. The budgetary line item language mistakenly identifies ICFs as “intermittent care facilities.” The correct term is “intermediate care facilities.”
2. As noted, language in the line item mistakenly implies that the Olmstead decision was intended to close ICFs. In fact, Olmstead held that:
We emphasize that nothing in the ADA (Americans with Disabilities Act) or its implementing regulations condones termination of institutional settings for persons unable to handle or benefit from community settings. . . Nor is there any federal requirement that community-based treatment be imposed on patients who do not desire it. (my emphasis)
3. A statement in the line item, which lists three conditions for discharging clients from ICFs to the community, leaves out one of the key conditions in Olmstead, which is that the client or their guardian does not oppose the discharge.
The House and Senate line item language states that in order to comply with Olmstead, DDS:
…shall discharge clients residing in intermittent care facilities for individuals with intellectual disabilities…to residential services in the community if:
(i) the client is deemed clinically suited for a more integrated setting;
(ii) community residential service capacity and resources available are sufficient to provide each client with an equal or improved level of service; and
(iii) the cost to the commonwealth of serving the client in the community is less than or equal to the cost of serving the client in an ICF/IID…” (my emphasis)
The first two of those conditions in the line item language are contained in the Olmstead ruling. The third condition about cost being less in the community actually isn’t contained in Olmstead.
The third condition in Olmstead for discharging clients from ICFs is that such a discharge is “not opposed” by the client and/or their guardian. That condition is not included in the House or Senate budget line item.
Here is the actual language from the Olmstead decision:
…we conclude that, under Title II of the ADA, States are required to provide community-based treatment for persons with mental disabilities when the State’s treatment professionals determine that such placement is appropriate, the affected persons do not oppose such treatment, and the placement can be reasonably accommodated, taking into account the resources available to the State and the needs of others with mental disabilities. (my emphasis)
We have asked Senator Michael Rodrigues and Representative Aaron Michlewitz, the chairs of the Senate and House Ways and Means Committees respectively, to consider redrafting this line item language to correct these mistakes.
Questionable effectiveness and little progress appear to characterize state’s efforts and proposals to raise direct care wages
With low pay a recognized cause of staffing shortages now endemic to the the state’s human services system, we are concerned about an apparent lack of urgency and effort by the administration and the Legislature in raising direct care worker pay.
We have called for a minimum wage for direct care workers in the Department of Developmental Services (DDS) system of $25 per hour.
Thus far, we haven’t been able to get key lawmakers or administration officials even to comment on our proposal. Those officials are similarly mum regarding the potential impact of their own proposals.
Meanwhile, as the staffing shortage problem drags on month after month, a lack of timely action by lawmakers and the administration to address it is especially frustrating given the state’s strong financial condition and projected surplus revenues.
Over the past several months, the Baker administration has distributed federal funding for only a one-time, 10% increase in wages under last year’s American Rescue Plan Act (ARPA). But those wage increases, which have been paid by at least some providers to workers in the form of bonuses, are not the basis of a permanent increase in their pay.
Questions about current bill to raise wages
A key bill in Massachusetts that is intended to boost direct care worker wages permanently is S.105, which was filed by state Senator Cindy Friedman. As Senate chair of the Health Care Financing Committee and vice chair of the Senate Ways and Means Committee, Friedman is one of the most influential and powerful members of the Legislature.
The intent of Senator Friedman’s bill appears to be good in that it would potentially boost the wages specifically of direct care workers in provider-run group homes and other facilities in the human services system.
But the bill doesn’t specify a minimum wage for those workers. Rather, it calls for an unspecified amount of state funding to close an apparently as-yet unquantified “disparity” in wages between provider-based workers and state workers.
I first contacted Friedman’s staff in early February to ask if they had an estimate of the amount to which her bill would raise direct care wages. I haven’t gotten an answer from her office on that.
Last week, after I renewed my query, Friedman’s communications director emailed me to say that Friedman “will be holding off on any official comment (regarding her bill) until the bill is finalized through committee.”
Friedman’s bill was reported favorably by the Children, Families, and Persons with Disabilities Committee in February, and sent to the Senate Ways and Means Committee. Prior to that, the Children and Families Committee had sat on the bill for almost a year.
I’m not sure what “finalized through committee” means, but I assume it means that Friedman won’t comment on her bill unless and until it is reported favorably by the Senate Ways and Means Committee.
It’s not clear why Friedman won’t publicly comment on her bill while the Senate Ways and Means Committee is still considering it. Legislators are generally eager to comment on bills they have proposed unless they either don’t fully support the measures or possibly don’t have answers to questions about them.
I wrote back to Friedman’s communications director, Stephen Acosta, last week, listing what I think are potential problems with the bill, or at least unanswered questions about it. We think a bill that specifies and requires a minimum wage for direct care workers would be a potentially more effective piece of legislation.
Among the problems or questions we have about Friedman’s bill are the following:
“Disparity” apparently hasn’t been quantified
The “disparity amount” is defined in the bill as “the monetary calculation of the average difference in salary” between direct care workers in provider organizations that contract with the state, and workers who are employed directly by the state.
Friedman’s bill would require the Executive Office of Health and Human Services (EOHHS) and other agencies, in collaboration with the Council of Human Service Providers, Inc., to calculate the amount of the disparity, and report back to the Legislature as of July 1.
Those entities would also be required to calculate the amount of state funding that must be appropriated to the providers to reduce the disparity over a five-year period ending in July 2027.
Friedman’s bill is a tacit admission that state workers are paid more for direct care work than are workers in provider agencies. But it appears that no one in the administration or Legislature currently knows what the difference in pay is.
As we have previously reported, the amount of that disparity has apparently only been “guesstimated,” and the guesstimate is that the disparity is roughly 20 percent. That guesstimate came from a staff member of the Children and Families Committee.
The federal Bureau of Labor Statistics lists an average hourly wage for “personal care aides” in Massachusetts of $16.29. Personal care aides, according to the BLS, include workers in both group homes and private homes.
If the Children and Families guesstimate is correct, it appears that even after five years, Friedman’s bill would raise the wage of a worker making $16 an hour to roughly only $19 – a level nowhere near $25.
Disparity would take five years to eliminate
We’ve written frequently about the need to raise direct care wages in order to address the ongoing staffing shortage affecting the entire DDS system.
Under S.105, state agencies, including EOHHS, would be required to raise funding for human services providers to reduce the wage disparity amount to 50 percent by July 1, 2023, and to zero by July 1, 2027.
Given the state’s current surplus in revenues, it seems to make little sense to wait for five years to fully fund the solution to a problem that is affecting the system and people’s lives right now.
No method of ensuring the money would go to direct care workers
Friedman’s bill states that, “ All increases in the rate of reimbursement provided (to human services providers) shall be used to increase the compensation of human services workers.”
But there are no specifications in the bill of any amounts that individual providers would be required to pay those workers. There is also no requirement that the providers show that the additional funding they receive under the legislation has, in fact, gone to direct care workers.
Approach has been unsuccessful in the past
In 2019, State Auditor Suzanne Bump found that a major boost in state funding in previous years had resulted in surplus revenues for providers, but had led to only minimal increases in wages for direct care workers.
Bump’s audit concluded that the increased funding, which was at least partly intended to boost direct care wages, “likely did not have any material effect on improving the financial wellbeing of these direct care workers.”
Bill based on average wages, not a minimum wage.
S.105 refers to eliminating an “average difference in salary” between provider-based and state workers. That could allow some providers to pay less than the average if others pay more.
We are calling for a minimum wage for direct care workers of $25 per hour. So, even if S.105 were to achieve an average wage of $19 an hour after five years, it would still imply a minimum wage of less than $19. That is another reason why it doesn’t appear that Senator Friedman’s bill would raise the minimum direct care wage to the neighborhood of $25 an hour.
Sudders has suggested a different approach to raising direct care wages
According to a March 7 State House News Service article, Health and Human Services Secretary Marylou Sudders testified that, “it might be time for the state to consider mandating a percentage of rates paid to private providers be used for salary enhancements.”
The News Service then quoted Sudders as saying, “Maybe we need to say 75 percent of our rates have to go to direct care salaries.”
Sudders was testifying at a hearing before the Joint Ways and Means Committee, which Friedman was co-chairing, according to the News Service. During the hearing, Sudders acknowledged workforce shortages in the human services sector.
The 75-percent idea has also been proposed before. In 2020, a bill would have required providers to use up to 75 percent of their total state funding to boost direct care worker salaries to at least $20 per hour. State Sen. Jamie Eldridge proposed a similar measure in 2017. Neither of those measures was enacted by the Legislature.
On Monday (March 21), I emailed EOHHS’s media relations manager, asking whether the agency had an estimate or projection of the amount to which such a 75-percent requirement would raise direct care wages. I also asked whether EOHHS had a figure regarding the current percentage of funding to providers that goes toward direct care wages.
Finally, I asked whether Secretary Sudders would support legislation to require a minimum wage for direct care workers of $25 per hour. I have also previously posed that question to Senator Friedman and the co-chairs of the Children and Families Committee.
So far, we haven’t gotten any responses to these questions. We urge people to call their state legislators and ask them to act on a $25 minimum wage for workers in the DDS system.
You can find your local legislators here.
COFAR blog 