I am making a proposal that Washington State should establish a “High Cost Review Committee” with representatives from Developmental Disabilities Administration, Aging and Long Term Care Administration, Behavioral Health, and other representatives from various professional disciplines, community advocacy groups and families, that are critical to the care of this population.
Listening to the discussion that took place at the Joint Legislative Executive Committee on Aging and Disability (November 30, 2017) I was struck by the different approach to fiscal discussions for long term care settings compared to residential settings for people with intellectual and developmental disabilities.
I was impressed with the information shared. The presenters were clear in the assessment of needs and costs and that those individuals with higher support needs have a higher cost of care. They take this information into account when making decisions for aging clients and also those with dementia. The presentation for Adult Family Homes indicated there are 17 different acuity levels for residents with correpsonding reimbursement rates.
One Senator asked for Clarity – clear ideas of the finances needed to try to meet the service need. Without a clear idea of the cost they are unable to understand what is needed.
I question why this approach is not used when making fiscal decisions for residential care within the Developmental Disabilities Administration. The data regarding acuity of care and costs is available to use but is not shared with those making budget decisions. Without an understanding of the number of residents in each level of acuity (Levels 1-6), the legislators are not able to make an informed decision.
Last year I was accused by one state Senator (Senator K.) of fabricating costs attributed to my son who lives in supported living when I shared those costs with another Senator (Senator C.). All I did was forward the DDA documents I receive to Senator C- if there was fabrication it was not on my part. Senator K stated that the data was irrelevant to the situation (cost of care of high support resident – seems very relevant to me)
Senator K wrote: “Unfortunately the numbers you are using are misleading and imply that community care services are more expensive than RHC care. Since the state pays for both, we have significant experience in many different clients and settings, the various elements of costs. We have used averages for our proposals because that is the most accurate way to account for a group of clients and settings. On average, community care is much less costly than RHC care.”
Using the AVERAGE cost of care is one reason that there is a crisis. It obviosly does not work to use this average for the budget purpose of the cost of care for residents with high support needs. Doing so will cause extreme underfunding of appropriate and mandated services. Doing so is neglect. My response to Senator K is linked here.
New Hampshire understands this fact about cost of care. They realized that in order to provide effective community based services to all individuals with IDD- including those with significant medical, behavioral and psychiatric needs, they needed a collective of responsible parties – policy makers, agea agencies, service providers, families and communities to play a role. The NH High cost Review Committee was formed in efforts to sustain and improve services for New Hampshire’s most vulnerable citizens. This report from the High Cost Review Committee has critical information on providing appropriate and cost-effective services for this population.
The Human Services Research Institute (HSRI) compiled information regarding the percent of the waiver budget for states was used by the 5% most expensive residents. This report was done in 2009 and they had hoped to update. I inquired into an updated version and unfortunately one has not been produced.
In addition to asking for an updated report of the 5% most expensive service users, I shared my concern about using “average” cost of care with the polcy analyst.
” My concerns are that the “average” cost of all people with IDD is used when looking at what it would cost to move people out of the ICF into a community home. Typically, the people in the ICF are those with higher support needs (hence higher cost) in the community and if one uses the average cost for community they will greatly underestimate the actual cost and the funding will not be available to safely care for the population. ”
This is the reply that I received from the HSRI Policy Analyst –
Your concern about the average cost of serving people is a valid one, as an average often masks outliers that can be important to consider.
Senator K and others in the legislature who believe the “average” cost of care is the number to use when trying to clarify budget needs – please ask for more accurate data from DSHS and DDA regarding at least the average cost of care for each assessed level of service. That information would be much more useful in forcasting cost and services than the overall average.