Supported Living Crisis

It is absolutely necessary that we provide funding to support our direct care providers in the community settings.  We have been in a crisis situation and it is only getting worse.  It is time to step up and provide the support that we all say is needed but do not provide the funding to back the words up.

Please read the position paper Underfunding of Community Residential Services by the Community Residential Services Association.  While I do not have all the cost reports of the community service providers nor the cost reports of the state funded services to compare the cost of care, I do know that the cost of direct care for those with high support needs is about equal across the board.

It is the costs of all the other services that add up and can make one type of residential setting appear more costly than another.  It also depends on what is included in the cost reports.  I believe there is cost shifting and capital costs which may not be reflected but, again, I do not know for sure since the data is extremely difficult to sift through.  It is something to take into consideration.

Regardless of the cost issue there are other major concerns that need to be factored in. Personal Choice of residential setting, access to quality health care, continued learning opportunities, employment and meaningful life activities all need to be included in the big equation.

There is not one type of residential setting that guarantees that all these aspects of life will be met or even considered but I do believe that living close to family, friends and natural supports does increase the chance that the person will have a meaningful life that is fully integrated into community.




The Almighty Dollar more important than peoples’ lives?

Below are excerpts from letters that I have received by those who make profits from residential services.  I understand the attacks against me since he views the accurate data being presented from original sources as a threat to his livelihood. 

What I would really like him to consider is the threat to the lives of those less able them him who will have all funding and resources cut if this data is not looked at accurately.  He is refusing to do that but instead throws arrows at me by saying the data is  manipulated.  The data is presented exactly how DDD records it in their records, how the agencies themselves report it to DDD and how the agencies themselves report to the IRS – hardly manipulated on my end. 

This CEO has clearly not read the reports nor is he aware that most of my research is geared toward improving the quality and safety of  care to those who do not reside in the RHC and to also bolster services and resources to people in the community at large.  His fear and anxiety about true data being exposed is clearly evident in his attacks.  It’s interesting that he does not counter-present with facts that would indicate what I have is incorrect  – I assume that is because those “facts” are non-existent. 

“I will not be communicating with you in the future as it is obvious that you are unable and/or unwilling to support community services, which is evidenced by your focus on presenting deliberately misleading data to state personnel and legislators.

Your lack of knowledge and understanding of services and funding is glaringly apparent in one report that you posted in which you claim that the “Cost correct for Resident Acuity” is over $850 per person for the Arc of King County, while you list the RHC costs at or below $200.  I fully understand that you are the parent of a person that resides within an RHC, and that you believe you are advocating for all people who experience an intellectual or developmental disability to have access to a continuum of care.  However, your approach plays as one-sided, is immensely inaccurate, slants towards de-valuing community residential services, and does notsupport a continuum of care.

Your continued efforts on a daily basis to distort the truth and inflate the data to present community services as more expensive sends the erroneous and destructive message to decision-makers that services can be further cut.  You are playing a dangerous role in your efforts and as such, I ask if you are even aware that your efforts will lead to further erosion of community services for people with developmental disabilities and will have grave and serious impacts upon those individuals who currently live independently in the community with community residential supports?

With regard to the data you present, I wanted to make some corrections.  It is important to correct these inaccurate figures since one of the reasons that we continue to face cuts is because individuals and organizations present data that has been either incorrectly calculated or misrepresented to somehow convey that community programs are more expensive, therefore being overfunded.  By presenting reports that state community programs are expensive, it sends the message to legislators that we should be cut.  This is part of the reason why we are in this crisis. 

Alpha Supported Living Services’ costs, on average, are above the average because 1) we are located in King County, which has the highest cost of living and therefore highest benchmark funding, and 2) we serve some more challenging individuals so our costs are higher than the average acuity level.  For example, over 40% of the individuals supported by our agency formerly lived in an RHC, 33% have a diagnosis of Autism, and approximately 40% have an accompanying mental health diagnosis.  As such, our costs are higher than the average due to acuity levels. “

This last point regarding costs are higher for higher acuity is one example that I have been trying to communicate – it is good to see that he recognizes that fact here but when speaking to legislators and the public, that would not be addressed.  As an example the attached graph indicates the cost of care as reported by each agency with respect to their reported “Average Hours per Day for Resident Care” – a measure that indirectly looks at client acuity.

Cost of Care chart with hours per day as reported by each Supported Living Agency

It is interesting to be aware that the average cost of care reported by DDD is $6400.00 a month.  This average cost is equal to about 11 hours per day.  On this chart, the highest reporting agency had 21.65 hours at $10,816 per month and the highest cost agency reported 18.22 hours per day at $15,620 per day. 

Another VERY critical issue is that these reported costs DO NOT include medical, dental, nursing, psychiatry, prescription medication, therapies, education, vocational training, habilitation, FOOD and RENT. 

My message as an advocate for a continuum of care is that these residents with high support needs are EXPENSIVE to care for no matter where they live.  It is more cost effective, safe and less restrictive for many of them to live in the RHC.  These are the FACTS – no manipulation, no inflation, only the facts. 

This is the information which needs to be shared and understood – when people try to cut corners and under-report, people die.  We have seen this happen already this past year. 

The Stand Opinion

Community Residential Services Association – Please Respond

In Attempts to better serve ALL our residents I have been on a mission to uncover some of the real information that we all need in order to make informed decisions.  This information will be questioned and I welcome that – it is the only way to get to the bottom of the problem.  This have been covered up for too long.

I have tried to communicate and ask questions with those in the residential care industry but they do not respond, nor do the administrators in the Division of Developmental Disabilities.  Below is part of my  latest letter to Scott Livengood, CEO of Alpha Supported Living and the Legislative Chairperson of Community Residential Services Association.  I do hope that he does respond to this illuminating data – not only to the questions about cost of care but about his own salary and the numerous vehicles which Alpha Supported Living utilizes.

I have gathered much information from the Certified Residential Care Cost Reports, IRS 990 Tax Returns, DD EMIS data regarding waiver costs and other DSHS costs for DD clients and also have reviewed many Residential Care Services  (RCS) Enforcement letters, mortality rates for various populations and the Certification Evaluation Reports for many of the supported living programs. 

From the above data I have made a chart which will be publicly distributed.  It clearly shows the cost of care by acuity, the profits that many of the agencies make (and also the losses) and people will be able to see that the reported average (by DDD) cost of care is much less than the actual cost – this is one area which continues to be misrepresented and causes much of the problem. It is important to note that very few of these agencies report the higher acuity that is found in the RHC but they routinely state they are the same.  By their own self-reporting, many are not even close to the  same acuity.  It must also be remembered that the majority of these costs do not include medical, dental, nursing, prescription drugs, therapies, food and rent.

  In reality, the cost of care is much higher than even this chart indicates.

I do have some specific questions for Alpha Supported Living though: 

  Your salary. Scott, is way out of line with the other salaries of other Executives – even though the 990 states the salary is comparable to the industry and regional standards. 

What region and what industry does it compare to?

Also, why does Alpha Supported Living have 30 vehicles? 

The agency sold 17 vehicles in exchange for leasing vehicles.  Who utilizes all these vehicles?

All Data from the chart in the link was secured through public disclosure or is public record.

cost of care as reported by each agency, DSHS payments, Profit and Loss

IRS 990 forms for Supported LIving, High Earner compensation, profits/losses

Supported Living Agencies, Residents and Automobiles