CT’s two-tiered human services system: ‘One tier too many’

THIRD IN A SERIES

Oak Hill, Inc., the largest nonprofit provider of human services for the state, recently trained two group home workers, only to see them jump to the competition earlier this year.

The competition is the state. Connecticut has an unusual two-tiered system of residential programs for persons with developmental disabilities.  The state runs some group homes and other residential facilities, and contracts with nonprofits such as Oak Hill to run others.

The work is the same; the compensation is not.

After years of flat or reduced budgets to nonprofits, the workers at nonprofit group homes have hovered just above minimum wage while their counterparts at state group homes are decently paid — they average nearly $30 an hour — with excellent benefits. Who could blame someone for going to the greener grass?

Those who leave are often the best employees, said Pamela Fields, executive director of MidState Arc Inc. The workers often go to positions paying them twice as much at DDS or the state Department of Correction, or elsewhere. “If they’re good,  they’re going to find someone willing to pay them more.”

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The wage difference drives turnover and staffing crises — evidence, critics say, that the two-tiered system is inefficient and expensive.

“It’s the state competing with itself. It’s not a rational way to run an operation,” said Jack Horak, lawyer and official of TANGO, an organization that supports nonprofits. He and others say the state could provide top quality services at substantially lower cost by expanding the use of nonprofits into more of a one-tier system.

State officials seemed to agree; in recent years they have moved dozens of group home operations to the nonprofit sector. But while they giveth, they also taketh away. During this transition, officials have been cutting the money going to these same nonprofits, causing them to abandon group homes, close or curtail other programs, and lay off workers.

The nonprofits say they can’t do much more with less. If the cuts continue — and the state’s budget situation looks grim for the next several years — there’ll be more loss of services and jobs, more fraying of the safety net and a questioning of the state’s commitment to serve its most vulnerable residents.

There is at least a glimmer of consensus on how to resolve this dilemma; it involves, in broad outline, a public-private partnership in which the nonprofits pick up all or nearly all of the residential services while the state monitors the operation and handles some specialized services.

The road from there to here

The current bifurcated system is largely the result of a reform movement.

Until the 1980s, most of Connecticut’s residents with intellectual disabilities who were in 24-hour care were located at either of the two state-run institutions, the Mansfield or Southbury training schools, both staffed by unionized state employees.

A federal class action lawsuit and other advocacy forced the closing of the squalid Mansfield campus in 1993, producing “a rapid expansion of community placements for the Mansfield population in community group homes,” according to a 2012 study by the General Assembly’s Program Review and Investigations Committee.

A reminder of the former state system: An abandoned building at the former Mansfield Training School.

And, per labor agreements with the state,  the staff who had worked at Mansfield had to be placed in similar state employment within a limited geographic area, which led to the development of state group homes in the area for former Mansfield residents and staff, the report states.  Nonprofit group homes expanded as well.

Hence, the two-tied system.

Per person difference: $151,202

The 2012 report and others reached one unanimous conclusion about the two-tiered system: it is expensive.

For example, a 2016 cost analysis from the Department of Developmental Services (DDS) reported that the annual cost per individual at a state-run group home is $265,062, while the same figure at group homes run by nonprofits is $113,860 — a per person difference of $151,202.

State officials have been aware for years that the nonprofits are less expensive, and have been shifting state-run group homes to nonprofit management for nearly two decades: in just three years of active transfers, a total of 55 group homes were moved from state to nonprofit management, according to data collected by The Alliance, which represents more than 300 nonprofits in the state. Ten more transfers are in the planning stage.

Ten state human service agencies contract with more than 700 nonprofits to provide an array of services to persons in need; persons with developmental disabilities, mental health or addiction issues, veterans, ex-offenders.

DDS, the largest contractor for residential services, operates 42 public group homes (also called Community Living Arrangements)  and funds 766 group homes operated by nonprofits, according to DDS chief of staff Kathryn Rock-Burns. The nonprofits serve about 10 times as many people as the state-run group homes, and apparently do it well.

The 2012 report looked at 17 group homes that had been run by the state but were now run by nonprofits — a change made possible by the 2009 state employee buyout —  and found that the nonprofit homes had nearly 40 percent fewer inspection deficiencies than they had under state management.

But, it’s not enough. There is a waiting list with more than 600 developmentally disabled people in need of emergency or urgent housing — they need a place to live now or in the next year— and another 1,100-plus who will need housing in the next five years.

The waiting list has been a longstanding issue, and a huge concern for aging parents with a developmentally disabled child at home. Many have looked longingly at the money being spent to operate state-run residential facilities wondered why it couldn’t be spent more efficiently for community placements. These include the group homes, three remaining regional centers and the Southbury Training School.

$1.3 million fuel bill

Connecticut Department of Developmental Services

Southbury Training School

Southbury is the largest residential facility run by DDS. The sprawling campus features a main building and 125 cottages on 1,400 acres. It was built as a Works Progress Administration project in the late 1930s and opened in 1940.  By 1969, it had 2,300 residents.

But with the 1970s came the push for deinstitutionalization, the move of persons with disabilities out of large institutions and into smaller community settings. Southbury has been embroiled in controversy ever since, or so it seems. Advocates of deinstitutionalization have fought to close it; relatives and friends of clients have battled to keep it open.

In 1984 the U.S. Department of Justice brought an action against the state for poor conditions at Southbury. Following a consent decree in which the states agreed to correct the deficiencies (it did), the state decided in 1986 to close Southbury to new admissions.

As a result, the population has both aged and shrunk, to about 200 residents today. It is very expensive. In fiscal 2017, the state spent a total of $78.6 million on Southbury, according to the State Comptroller’s website.

“We could put a huge dent in the waiting list if the state stopped providing direct (residential) services,” said Tom Fiorentino of West Hartford, an activist parent, president of the Arc of Connecticut board of directors, and former assistant attorney general who believes the current system is a major drain on state resources.

But, Rock-Burns of DDS cautions, closing the facility is “not as cut-and-dried as it might appear.”

The population is mostly frail and elderly —many younger people have already moved out —  and will require careful planning to find appropriate new residences, which could take years for all 200 residents. Workers are protected by union contracts and will have to be reassigned, as they were when Mansfield closed.

Nonetheless, closing Southbury would save money — the fuel bill alone is $1.3 million, money that could place 10 people in community settings, according to the Alliance (assuming the legislature would allow DDS to keep and reinvest the money).

Underfunded and underpaid

If the dual system is phased out, the nonprofit sector is likely to need more resources.

About 20 percent of the workers in nonprofit group homes under contract with DDS are members of SEIU 1199, the bargaining unit for 26,000 health care workers in the state, including workers in state-run group homes. The nonprofit workers at DDS-funded group homes, most of whom hadn’t seen a raise in more than a decade, threatened a strike this spring and won a wage increase to $14.75 an hour, with those making more than that getting a five percent increase, taking effect at the beginning of next year.

Some nonprofit group home workers are now making $11 – $12 an hour, according to the Alliance and the union, a salary so low that many of them need to rely on government programs, such as food stamps or housing subsidies, and have second jobs. Workers at other human service nonprofits got a one percent cost of living adjustment.

Though the workers got a small raise, the nonprofit organizations themselves didn’t get a rate adjustment to cover the increased costs of such things as health insurance, electricity, heat, etc. , and haven’t had such an adjustment in more than a decade.

This illustrates a major reason nonprofits are less expensive than state-run facilities: they have been underfunded and their workers are paid low wages.

Advocates say the nonprofits need enough money to keep their facilities and programs open and running. Also, nonprofits workers can be expected to push for better wages and benefits, as befits their challenging work. Barry Simon, president and chief executive officer of Oak Hill, suggested that if workers reached the midpoint between what they make now and what state group home works make, say $21 — $23 an hour, they would be more fairly compensated and the state would still save money.

Pat Johnson, former head of Oak Hill and of Catholic Charities for the Archdiocese of Hartford, said a main advantage of nonprofits is that “they are incredibly flexible — they have to be, in order to survive. The state tends to be more rigid.”

Asked what a better system would look like, several people — including SEIU 1199 president David Pickus — gave variations of this: A public-private partnership in which the remaining state-run group homes would be run by nonprofits and the state would provide inspection and oversight as well as specialized services such as speech, occupational or vocational therapy when these services aren’t readily available in the client’s community.  The state could also coordinate emergency placements: DDS is developing a crisis response program to intervene when clients need “behavioral  stabilization” so they don’t end up in emergency rooms, as some do now.

Southbury and the regional centers would close, with the workers and savings assigned to community services.

It will take resources and imagination to revamp the system. Meanwhile, the turnover and uncertainty continues. After losing two group home workers to the state earlier this year, Oak Hill recently had a manager move to the state as well.

Paul Marks contributed to this story.

 

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