Seattle Times Editorial – DD Waiting lists

I like to think that if the validity of a report is questioned, the responsible thing to do would be to check it out.  Not so with the Seattle Times with regards to a recent editorial “End waiting list for people with developmental disabilities“.

Yes, it is absolutely true that we need to end the waiting list for supports and services and for this I believe every advocate for people with developmental disabilities is thankful, but what the Seattle Times and other so-called advocates continue to talk about is the inequity of services and supports.  The “haves and have nots” as the recent DD Audit termed the problem.

I’m sorry that the Seattle Times editorial staff will not look at this issue and the concerns that have been raised regarding the validity of the DD Audit.  Our state should not base any legislation or policies on data which was reported in the recent state performance audit of the Developmental Disabilities Administration.

I submitted an essay to the Seattle Times regarding this issue but they have declined it.  I am publishing here in hopes that the citizens of our state read this and understand the problems and misleading and downright false information which has been reported.  We can not just accept without questioning – particularly when some major errors have been identified and pointed out.

In response to the recent editorial from February 9, 2014 entitled “End Waiting List for People with Disabilities”:

I fully support expanding community services for those with developmental disabilities and their families.  However, it is wrong to argue that the lack of services, supports, and funds for those in community settings is somehow due to the money spent on those living in the Residential Habilitation Centers (RHCs).  This “haves vs. have-nots” mentality has been propagated by supposed advocates for those with intellectual/developmental disabilities, and is based on misleading and biased research fostered by those with an agenda to close the RHCs, a move that would be disastrous for our most vulnerable citizens and entail not a savings but a much greater expenditure of funds.

Rather than seeking objective research, our State Auditor hired out-of-state “experts” who pride themselves on closing RHCs to manage the project team that provided the data for the Developmental Disabilities Administration (DDA) audit.  This has meant that the audit contains critical omissions, inaccurate data, and false assumptions, with dire implications for our system and those it serves.

What’s going on here is an extreme case of cost-shifting.  The RHCs are medical facilities providing full, comprehensive medical, nursing, pharmaceutical, psychiatric, therapeutic, vocational, recreational, and behavioral care in addition to daily staff helping with the activities of daily living for residents.  All of these services fall under the DDA budget.  Community support, on the other hand, entails individually utilizing programs and funds in an a-la-carte fashion from as many as seven programs under the Department of Social and Health Services (DSHS).

What is crucial to keep in mind is that a person with acute needs in a community setting draws on far more resources than what appears on the DDA budget.  They draw from DSHS Medical, Economic, and Mental Health programs, local and state budgets, emergency response teams, hospitals, clinics, therapeutic resources, and so forth.  All of these costs are ignored by the audit, which looks narrowly at the DDA budget alone.  Information on these costs is readily available through the Integrated Client Data Base, but the auditors chose not to look at it.  Had they looked, they would have seen that 35% of those on the DDA budget receive paid supports from at least three other DSHS programs.  Moreover, each residential agency is required to submit an annual certified cost report of its expenses, something again ignored by the DDA audit even though this data is crucial for understanding where the funds go and how they are utilized.  Finally, the DDA is even ignoring its own data.  Its cost of care figures show that the top thirty developmentally disabled clients in the community cost an average of $598 each per day, while the cost of the same level of care for those with similar needs is $248 per day in the RHCs.

Space does not permit me to note all the other flaws with this audit.  (For example, in assessing support needs, the auditors omitted four of the seven standard areas of assessment).  To sum up, the audit is little more than a hatchet job aimed at RHCs.  It ignores the information most pertinent to the actual costs of care inside and outside of RHCs, and manipulates what data it does use.  What we have here is a shell game, but its victims are not unwitting Seattle tourists on a Times Square vacation, but rather those who most direly need the services of the RHCs, and the citizens of our State who will be stuck with the bill for a “reform” that costs more but delivers less.

I do hope that The Seattle Times Editorial Staff will take time to read this information and re-think their support of such a false report.

Editorial board members are editorial page editor Kate Riley, , Ryan Blethen,  , , Jonathan Martin, Thanh Tan, William K. Blethen (emeritus) and Robert C. Blethen

Our Citizens are worth the fight to maintain civil rights

Let’s uphold the civil rights of all of our citizens, regardless if they are able to stand up for themselves or make their voices heard.

Over and over again, we hear about a fictitious number of DDD clients who do not receive services, we hear about  how keeping our RHCs open takes away services from those who may need services and our most vulnerable citizens with the most complex needs are continually accused of using more than their share of the pot which makes others go without. 

 This is the “Big Lie” that is told over and over again by agencies which masquerade as Disability Advocates.  They state that it is cheaper to care for these individuals in the community – yes, that’s true if you do not support their assessed needs.  That’s this issue – these individuals have needs that have been assessed and they are in the environment which best supports their needs in order for them to be as active and successful in their life and community as they can be. 

 Yes, there are individuals with just as complex needs living in the community – no one is denying that fact.  Also, no one is telling those individuals or their families that their care is too costly so they will be evicted.  These individuals are celebrated for the fact that they live in the community  – no matter what the cost.  But I ask, are they really “in the community?”

 I’ll tell a story of a man that has recently moved out of Frances Haddon Morgan Center.  This man has been celebrated as a success for the Roads to Community Living Grant.  I attended a parent gathering this past spring which was geared at informing parents/guardians of the benefits of moving their loved ones out of an institution.  Brock was the example they highlighted in showing how great this program could be.  There is a video on Youtube entitled “Brock 8” which refers to this gentleman.

 At this gathering, we were told that the transition for Brock was very intense involving many specialists and took about 2 years.   In those two years, there was much property destruction that needed to be fixed due to Brock’s behavior.  Brock and anyone who would be working with him needed to be trained in the Picture Exchange Communication System (PECS) which Brock would be using in his new job situation.  Everyone from the Residential agency, DDD and other programs which were involved with Brock’s transition spoke to the difficulties but that over time (2 years) Brock was able to live in a community home and have a job. 

 What was very interesting to me was that they then said, “He had that job for about 2 months but isn’t working now but we won’t go into that.”  I took that to mean that this expensive experiment wasn’t as successful as they wanted to picture it so they were going to end the success story at this point.   I later asked about this but due to HIPPA, I am not privy to the information but was told that yes, Brock was not working but was “volunteering.”  There had been a change in vendors and since it had taken several months to train the previous vendor, it would be anticipated that there would again need to be months of training for a new vendor. 

 I do know that there are two young men who have moved out of an institution into a community home.  For these two men, who cannot have others living with them due to safety issues, the staff and housing for each of these men is at least $500,000 a year.  (DSHS)

 I was provided with the list of the 30 most expensive clients for community residential clients by DDD.  The average annual rate for this group is $218.000 per year (range = $181,603- $353,973) – that is only the portion of care that DDD expends.  This does not include other services in the DSHS package such as medical, economic aid, transportation or food stamps.   There are other clients who receive 16 hours private duty nursing care in addition to other services to enable them to live in a community home.

{For reference, the average annual comprehensive cost for an RHC resident is $186,000 (DSHS)}

 These are the complex care clients who live in the community and these clients are expensive no matter where they live.  Moving more complex clients out into community homes against their wishes only for the sake of ideology of the masquerading advocates is a nightmare.  There is so much wrong with this scenario yet because of the untruths and rhetoric that are continually published without question, people believe what they are told. 

 

Our citizens deserve better. 

 When a person chooses the environment which works for them as guaranteed under Federal Decisions, no one should be able to evict them from their homes.  On top of this, the reasons given are under false pretenses:  less expensive, more involved in community, better care – none of these reasons can stand up when the facts are presented.  The problem is that the facts are not presented or presented but tossed aside because they do not support this ideology gone awry. 

 One huge part of this problem is due to the silo effect as explained in my previous post.  Sure, maybe moving a client out of the institution would make the DDD budget less but those costs are still there under another program within DSHS or put upon the community (as in increased emergency calls to the Fire and Police Departments.)  It’s time that our government, legislators, advocacy agencies and citizens were responsible and looked at the whole picture of care – not just the peephole that suits their cause. 

 It is clear from actually looking at the figures that in reality, the comprehensive care in the RHC is much more cost effective than care for an individual who chooses to live in the community.   I don’t understand why the residents who choose to live in the RHC, which is clearly a cost effective care center which supports their assessed needs, are harassed and threatened with eviction, due to their care being expensive when in reality, their care is less expensive than if they chose a community setting. 

 Yet, if they chose a community setting, the cost of their care would greatly increase, yet these same advocacy groups who complain about their current care being too expensive, would then celebrate in the fact that their care is now community based, yet much more expensive.   

THIS JUST DOES NOT MAKE SENSE if one really cared about the person.  So, obviously, this issue is not about the care of the person but about something else.  Who are these advocacy groups really advocating for? 

 

 

Works Cited

DSHS. “DSHS Client Services FY 2007-2008.” n.d. http://clientdata.rda.dshs.wa.gov/ReportServer/Pages/ReportViewer.aspx?/CSDBAnyYear/Landscape_StateClientSvcsByAge.


Washington State Senators who voted “Yes” on SSB 5459 are tagged in this message.  I don’t believe that these Senators were exposed to the real issues or that the facts were presented to them.  I believe that their decisions on this case may have been based on rhetoric and false assumptions that prevailed in the legislative session.  I would love to talk to any of them and try to educate them on the real issues with real people and real cases involved.