RI Senate President Favors Reforms in Developmental Disability System

By Gina Macris

  The time has come to reform the way Rhode Island supports people with disabilities, in particular by elevating the status of an underpaid workforce that provides direct care, the state Senate’s top leader says.

“This is a really an exciting and challenging time,” Sen. M. Teresa Paiva Weed, D-Newport, said Feb. 24, winding up a two-day conference at Rhode Island College that focused on strategies for attracting and retaining more highly skilled employees.

Paiva Weed said she was initially very concerned about a federal consent decree that requires Rhode Island to improve community integration of people with developmental disabilities, but “I have in my head decided that it offers an opportunity to transform our system if we all work together and meet the challenges.” 

Her show of support for developmental disability professionals comes at a critical legislative and legal juncture for Rhode Island. 

An independent Court Monitor said in January that the state has not allocated enough money to meet compliance goals spelled out in the consent decree, and the federal judge in the case indicated he is prepared to take further action to enforce the decree, if necessary. 

Paiva Weed noted that some people undervalue the care-taking workforce – and that those perceptions must change. 

“It’s okay to pay $25 an hour for somebody to throw paint on your wall,” the Senate president said. “But when you want to pay someone $15 an hour to care for people, everybody has a heart attack.”

 In Rhode Island, these workers earn roughly $11 an hour, on average.  

Paiva Weed said that a key Senate panel, the Committee on Health and Human Services, would get a briefing from the independent Court Monitor overseeing the state’s compliance with the consent decree the day after the conference, Feb. 25. The session was scheduled to start at 3 p.m. in the Senate Lounge. 

The Senate President said the legislature, the public, and even families of people with developmental disabilities need to be educated about what the consent decree means, reiterating one of the themes that had run through the conference.   

Paiva Weed said she has heard from constituents who are “very angry” with plans to fund community services largely by shifting residential costs from expensive group homes to shared living arrangements with individual families. About 500 of 1300 people living in group homes would move by June 30, 2017. 

“It’s a divided community,” she said. “Maybe some of it can happen through attrition. Maybe some of it can and some of it can’t,” she said, echoing doubts about the schedule for moving so many people in such a short time that were recently voiced by a spokeswoman for direct service agencies that oversee shared living. 

 “There are a lot of people who are huge advocates for you guys, but this is complicated and a lot of folks don’t understand how complicated this is,” the Senate President said.

Paiva Weed did not offer new suggestions about increasing the low pay of the developmental disability workforce, a key element in attracting and retaining employees.

Her guest appearance capped a series of brainstorming sessions that brought together state officials, community service providers, and a few family members of people with disabilities under the auspices of RIC’s Sherlock Center on Disabilities. 

In the end, the discussions gelled into concrete plans for the state Department of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH) to launch a small model program on July 1 to showcase high quality training, effective supervision, and better wages for workers wo called direct support professionals.  

 Maria Montanaro, the BHDDH director, said it will require planning on an “aggressive schedule” to roll out a model program of best practices in developmental disability services by July 1, “but I think we can do it.”  Private agencies would apply to have their staff participate in the program.

 The program design must be completed by the end of March to allow time for approval by the state’s Executive Office of Health and Human Services, the legislature, and the federal Centers for Medicare and Medicaid Services, Montanaro said. 

Montanaro envisioned higher pay for workers in the pilot program, training that would lead to certification, and the use of smart devices to help people with developmental disabilities do a variety of tasks more independently and monitor them at critical times.

 At the same time, the BHDDH reimbursement rates to private agencies must be reconfigured, and regulations must be altered so that they do not collide with the planned innovations, said Andrew McQuaide, the department’s chief transformation officer.

 If the pilot program is successful, it could be implemented system-wide in 2018, he said. 

 An expert on implementing community-based services for people with developmental disabilities, Amy Hewitt of the University of Minnesota, advised the Rhode Islanders that any certification process should be voluntary if it is to succeed in the long run, suggesting that incentives and rewards work better than top-down rules.

 Questions remain about the details, including the use of technology. While proponents cited positive examples of smart devices that reduce the need for staff to watch routine activities or to provide reminders, one parent, Pam Goes, said she was concerned about the loss of privacy that might come with technology, such as TV monitors, even if they are only used part-time.