The costs for serving particular (Fernald) residents in community settings would be based upon a careful assessment of what supports would be needed in order to provide them with equal or better care in the community. Such costs vary according to an individual's particular needs but, in the Department's experience, transitions to community-based programs have historically cost less than providing services in an ICF/MR (a state facility) (our emphasis).
But how does it cost less in the community? Howe doesn't come right out and explain that. But she does go on to state in her letter that the Department's relatively low calcuated cost of $102,000 per resident in the community was based on "the average cost of community-based services" (our emphasis again). And that's precisely the problem. The population in the facilities and at Fernald, in particular, isn't average for the DMR system. Eighty-six percent of the Fernald population was listed as having severe or profound mental retardation in 2001. That percentage is even higher today. Most residents of the community-based system have mild to moderate levels of mental retardation. DMR's $102,000 cost estimate for care in the community is based on an average population in the DMR system. Their estimate of $239,000 for care at Fernald is based on the budget of a facility that primarily serves people with severe and profound levels of mental retardation and extensive medical needs. Leaving aside our contention that the $239,000 is an inflated figure, it stands to reason that clients who have higher clinical and medical needs would need higher levels of staffing for their care, which adds to the cost of that care. If, in fact, equal or better care is to be provided in the community, then the direct-care staffing levels in the community must be the same as, or higher than, those in the facilities for clients with the same level of care needs. Yet, Howe simply states that equal or better care will be provided in the community for these former facility residents at less cost. As noted, she doesn't come out and say it, but there's only one way to achieve that lower cost, and that is through lower direct-care staffing levels and/or lower pay and benefits. That might work for people with mild or moderate mental retardation, but it won't work for the people at Fernald. Yet, this appears to be what DMR is counting on when Fernald and the other state facilities are closed: that those former facility residents will be cared for by fewer staff who are lower paid and don't have health care benefits. And somehow the care will be equal or better. That's the disconnect. |
