By Gina Macris
Reacting to the recent death of a group home resident in Providence, Rhode Island, State Senator Louis DiPalma is seeking a thorough review of state-run housing for adults with developmental disabilities.
DiPalma put his intentions in a legislative resolution that unanimously passed the Senate Committee on Health and Human Services May 31. The committee chairman, Sen. Joshua Miller, (D-Cranston and Providence) and three other committee members are co-sponsors.
The resolution needs a floor vote in the Senate before it is submitted to Elizabeth Roberts, the Secretary of Health and Human Services.
The measure asks the Executive Office of Health and Human Services to review the “structural, programmatic and policy changes needed to best address the licensure, regulation, and oversight” of the 25 group homes run by the Department of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH) under the name Rhode Island Community Living and Supports (RICLAS). EOHHS would report back to the Senate by Jan. 4, 2017.
HHS Secretary Roberts recently acknowledged that the conflict between BHDDH licensing and investigating its own group homes must be eliminated.
A total of 155 people live in the 25 state-run homes as of June 1, according to a BHDDH spokeswoman. In contrast, there are about 1,118 in the private system.
The resolution asks EOHHS in its oversight role to make sure that individuals with intellectual and developmental disabilities have high-quality residential services that are both cost-efficient and safe.
The death of Barbara Annis at the former College Park Apartments highlighted health and safety issues within RICLAS, but there also have been concerns about the high cost of operating the state system, particularly when BHDDH has admitted it does not pay enough to cover the actual expenses of private agencies providing most of the residential and day services.
The BHDDH-licensed and operated RICLAS homes cost an average of $544 a day for each resident, more than twice the average daily cost of $197 per person in the private group home system, the BHDDH director, Maria Montanaro, told the House Finance Committee recently.
After the May 31 HHS Committee meeting, Miller, the chairman, questioned whether those figures were accurate, saying he didn’t think they reflected the more complex needs of residents in RICLAS homes.
Spokespersons for private group home operators and BHDDH itself dispute the notion that RICLAS residents have greater needs than those in the private group homes. Both systems have about the same proportion of clients who require extensive services, said the BHDDH spokeswoman, Linda Reilly, although RICLAS homes tend to have older residents.
Montanaro, the BHDDH director, has said that the state created RICLAS for former residents of the Ladd School, the state institution for adults with developmental disabilities, which was closed in 1994.
Montanaro said RICLAS was envisioned as a temporary measure until the state could grow a private network of service providers to serve adults with a wide range of needs.
The privately-run system is now fully developed, she said, but the state has continued to run RICLAS, albeit with fewer homes than there were years ago.
The union representing state workers in RICLAS homes, Council 94 of the American Federation of State, County and Municipal Employees, vigorously defended its members when it appeared early in the current legislative season that Montanaro might reduce the number of RICLAS homes by convincing residents to move to less costly shared living arrangements in the community. That shift has not materialized, at least not in the short term.
Asked about DiPalma’s resolution seeking a review of RICLAS, Jim Cenerini, the union spokesman, said he would withhold comment until after the study is completed.
Besides DiPalma and Miller, other co-sponsors of the resolution are Senators Gayle L.Goldin, (D-Providence), Cynthia A. Coyne, (D-Barrington, Bristol and East Providence) and Adam J. Satchell, (D-West Warwick). DiPalma, a Democrat, represents Newport, Middletown, Tiverton and Little Compton.
Among other things, the resolution asks EOHHS to make sure all residents of state-run group homes have up-to-date individual service plans, detailed formal agreements between clients and the state that serve as foundations or “blueprints” spelling out the goals of each person supported by BHDDH and the services and needed to help each one make progress.
Some residents of RICLAS homes do not have current individual service plans, which are supposed to be revised annually, according to a BHDDH spokeswoman.
These plans are also necessary for compliance with a 2014 federal consent decree between the state and the U.S. Department of Justice intended to give persons with disabilities choices in how they lead their lives.
In an interview, DiPalma talked about another worrisome issue, that of pay disparity between the state and private systems.
He said RICLAS employees make between $15 and $25 an hour, while workers in the private system make poverty wages, ranging from $10 to $13 an hour.
The union for RICLAS employees negotiates pay scales with the state.
Direct care workers in the private sector were making as much as $15 an hour until 2011, when the General Assembly cut a total of 13 percent - $26 million – from payments to private disability service agencies.
Budget increases enacted since that time have been used to close chronic deficits in developmental disability spending.
Governor Raimondo’s proposed budget would allow private agencies to give raises of no more than 60 cents an hour, DiPalma said.
“That’s still not enough for people who do God’s work,” he said.
DiPalma said he is determined to press for a minimum of at least $13.97 an hour for direct care workers in developmental disabilities, with future raises linked to the consumer price index.
A bill he sponsored establishing that $13.97 minimum appears to have died in committee this year, because it would have cost tens of millions of dollars to implement, but he said he plans to do additional research and reintroduce the legislation in the next session.
What the state pays private-sector workers for extremely difficult jobs “is just not right,” he said.
In a telephone interview, DiPalma said that what happened at the state-run College Park Apartments can never happen again. He referred to the death Feb. 15 of Annis, a 70-year-old resident who had a leg fracture that went untreated long enough for an irreversible infection to set in. College Park has since been closed by BHDDH.
“We need to be proactive and figure out what the issues are,” he said.
Without outside oversight of the RICLAS homes, the state will not be able to ensure that individuals receiving state services get “quality care at the right time at the right place,” he said.
Meanwhile, as a result of Annis’ death, five employees of College Park Apartments were placed on paid leave and the home was closed March 25. Both the Rhode Island State Police and the Medicare Fraud and Patient Abuse Unit of the state Attorney General’s Office have launched criminal investigations.
Between December and March, there were two other reports of alleged patient abuse or neglect at College Park. In one, a woman complained that a staff member assaulted her, and in the other an 89-year-old woman was found unconscious with head and shoulder injuries and revived, according to internal BHDDH reports.
There was a nine-hour delay before the 89-year-old woman was sent to the hospital for a check-up. She was held overnight – and neither that incident nor the alleged assault was reported promptly as required to internal BHDDH investigators.
The internal BHDDH reports were released by the Attorney General in response to a request by Developmental Disability News under the state Access to Public Records Act. The office declined further comment on the two incidents, saying the cases are still open.