Budget concerns shift perspective from group homes to shared living

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After being one of several state departments flagged for overspending, the Department of Behavioral Healthcare, Development Disabilities and Hospitals (DBHDDH) presented a plan to the House Finance Committee January 12 to cut spending by moving 300 individuals with developmental disabilities from group housing into residential or shared living arrangements (SLA) by the end of March.

Currently, around 3,800 persons with development disabilities receive state care and 1,300 of them live in a group home.

In a phone interview Tuesday afternoon, Charles Williams, Associate Director for DBHDDH, explained that it costs the state less for SLA than it does for group housing. The daily state aid toward group housing is $162 versus $109 in shared living. On average the annual savings for an individual in SLA over group housing is $19,400, with that number increasing depending on the severity and dependence on services.

At the House Finance Committee meeting, Director Maria Montanaro estimated that, should the department reach its goal of 300 persons, it could save $3.76 million towards the nearly $6 million shortfall.

Despite the financial push for this initiative, Williams explained that in general, there is a nationwide “shift” from group homes to SLA.

He said although group homes are within the community, SLAs are a “preferable” option for many because there is a more individualized and community-integrated experience. Participants in SLA have the opportunity to become “part of the family.”

Where some were concerned this could lead to the extinction of group homes, Williams argued that group homes will always have a place for those individuals with more complicated conditions and require a broader spectrum of services and supports.

“This isn’t an all or nothing argument, that is not what we are trying to do,” Williams said.

Those within the community worry that moving 300 individuals in such a short time is too “aggressive.”

Gloria Quinn, the executive director of West Bay Residential Services believes the initiative is rooted in good values, but points out successful SLA matches take time and 300 is a large number to undertake in less than three months.

For an SLA, interested families see profiles of individuals considering SLA. Then the two parties take time to get to know one another to see if it would even be a compatible match. The households and families undergo inspections, background checks, and a series of licensing, all of which Williams said himself takes, on average, about 30 days.

Quinn said West Bay just had a successful transfer of a client from group housing to an SLA and are working on another but remains skeptical of the statewide goal.

“We are working just one person at a time. To have positive and stable matches, it’s a time consuming process,” she said. “This initiative must be created in a way that it does not destabilize the services already in place.”

Although she agreed that individuals with developmental disabilities have the right to choice, she says any plan that looks to move such a large number of persons needs more planning.

Williams agrees 300 is a concerning number, and the department may not achieve it by the end of March, but said DBHDDH is committed to working and moving as many as possible and making available all the resources necessary to move this forward.

“We are aware this could cause some disruption in the system, but we are planning and preparing to minimize that,” Williams said. “From our perspective this is the direction to go, and it’ll be better in the long run with a more individualized and integrated process for all.”

He noted that this initiative would more likely than not continue after the March deadline.

Williams said that as more people move to SLA – and Quinn was in agreement – there would be no loss of jobs, but certain positions will have to be re-purposed or adjusted to the new system.

So far there has been interest in both individuals looking to move from group homes as well as those families looking into taking an individual into their own home.

Williams explained that nearly everyone in a group home is a candidate for SLA, but because this is a voluntary program it may not be for everyone. He said especially those who have lived their entire lives in the group homes, the prospect of moving is “anxiety provoking,” but those who have participated in an SLA have only had positive experiences. He believes that as others see the success of the program it will only fuel the interest of others to participate.

The DBHDDH has 100 potential families lined up for the initiative, willing to take in an individual with developmental disabilities. Quinn said several West Bay clients have expressed interest in moving as well and as an agency West Bay is looking forward to offering more SLA opportunities.

“We are excited to be sitting at the table. This agency needs to stay person-centered. I think it’s a good option if it is just afforded the appropriate time,” Quinn said.

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sshenfield

Everyone agrees that shared living (also known as adult foster care) may be suitable for people with mild disabilities but that the most severely disabled need skilled round-the-clock care by properly trained staff in group homes. The question is where to draw the line. According to Mr. Williams, nearly all residents are candidates for foster care and BHDDH is committed to moving as many as possible. However, informants with long experience working in the RICLAS group homes tell me that MOST residents have severe developmental and/or physical disabilities. Many are confined to wheel chairs, nonverbal, incontinent, have very difficult behaviors, etc. Can an ordinary family, quite likely doing it only for the money, really be trusted to provide an adequate standard of care? If there is neglect or abuse it will be much harder to detect in the isolated environment of a foster family than in a group home where there are always other people around. And what happens when the foster carers grow old?

Many residents have developmental disabilities so severe that they are unable to express their preferences and make a free choice. Will they be moved?

I have started a petition against this ill-conceived plan on change.org. I hope you will sign it (go to that site and do a search on "Shenfield" to find the petition). See also my article on this issue at RIFuture.org.

Friday, January 29, 2016