Fact or Fiction Part 2

cost center

“Average” Daily Rates in Washington State for residents with Developmental

Disabilities who live in 4 types of Supportive Residential Care

Regarding the cost of care, it is clear that the comprehensive cost of the care of those with the highest support needs who choose the RHC is the most cost effective care.  As revealed in the report “Assessment Findings for Persons with Developmental Disabilities Served in Residential Habilitation Centers and Community Settings” (2011) residents in RHCs had significantly higher support needs than community residents.  The RHC residents were also significantly more likely to meet both extensive behavior and extensive medical support needs than residents in community residential programs.  “Our current findings suggest very clear difference in medical support needs, with those in RHCs being more likely to have high medical support needs than those in community residential programs.” (Barbara A. Lucenko, PhD and Lijann He, PhD, 2011)


This report also examined the DDD Acuity Scales and found that the residents in the RHCs also  had significantly higher support needs in interpersonal support, protective supervision and Activities of Daily Living (personal care, dressing, bathing, eating) in addition to medical and behavioral support needs. 



Looking at the daily cost of care in each cost center, it is also clear that there is much cost shifting in some areas which make it appear that the cost of care is less expensive.  This is the information that is often not shared when comparing costs.  It is also critical to look at the support needs of the residents in each setting, realizing that those in the RHC have significantly higher support needs and inherently higher costs related to the higher support need.


One other area that is misrepresented is that the “community” ICF/IDs offer the very same services as the state run supported communities of the RHCs.  It is clear by auditing their costs that this is not the case.  Knowing the high support need of the average RHC resident, it is very clear that this average RHC resident could not be safely and cost-effectively cared for in the “Community” ICF/ID since the comprehensive services are only available in the RHC. 

Please see this link below for a description of the cost centers and more information on the data 

 Average Daily Cost of Care


Barbara A. Lucenko, PhD and Lijann He, PhD. (2011, February). Assessment Findings for Person with Developmental Disabilities Served in Residential Habilitation Centers and Community Settings. Retrieved from http://www.dshs.wa.gov/pdf/ms/rda/research/5/36.pdf

In Washington State the term Residential Habilitation Center (RHC) is inclusive of the ICF/ID and the specialized Nursing Facility.  The costs in these reports are only for the ICF/ID part of the RHC.


In hopes of understanding the Support Intensity Scales Assessment

This posting is very complicated.  I’m trying to make the Support Intensity Scales (SIS), which are used to assess our folks with ID, understandable to those who are reading reports.  These scores are used and have been reported in “research” by DDD but unfortunately, the author does not report the significance of the scores nor use as they are intended by the developers of the SIS.  My hope is to clarify the issues and to show what these scores really do represent by the assessments that were completed in Washington State.

Information regarding the Supports Intensity Scales (SIS) – used in Washington State to assess the support needs of individuals with Intellectual Disabilities.

The purpose of the SIS has 3 sections:

Section 1:  Support Needs Scale – 6 Life Activity Areas

  1. Home Living Activities
  2. Community Living Activities
  3. Lifelong Learning Activities
  4. Employment Activities
  5. Health and Safety Activities
  6. Social Activities

Section 2:  Supplemental Protection and Advocacy Scale (WA does not use this portion in the DDD assessments)

Section 3:  Exceptional Medical and Behavioral Support Needs – to be seen as significant, the score on this section must be greater than 5 (range 0-32 Medical, range 0-26 Behavioral) or have at least one area score a 2 (range 0-2).  If the answer is yes to any of these questions, it is highly likely that the individual has a greater support need than others with a similar SIS Support Needs Index.

The presence of exceptional medical and behavior support needs is higher in the RHC populations than the other two populations.   Those who score in “exceptional need” will have higher support needs than other clients who may have the same Support Needs Index Score.

This graph indicates the frequency distribution of the Support Needs Index – you can see it follow the typical bell curve.  The cost of care increases as the SIS increases.  For those with significant exceptional needs, their cost of care will be more than someone else with the same SIS Support Needs Index Score.

It is clear from the data presented that those in the RHC have significantly higher support needs and exceptional medical and behavior needs than the residents in the Community Residential and Other Community Residential.  I have written to Barbara Lucenko and Lijian He, authors of the DDD Report several times to have them clarify and correct their information or to at least explain thier conclusions but they have not responded.  I hope that other research which is done in our state is more reliable than some of these reports published by DSHS.