For the developmentally disabled, it's public vs. private care

Pauline Bouffard says her son used to hold his arms out every time she visited him at the state-run residential facility for the developmentally disabled in Meriden, signaling his desire to go home. Now he lives in a private, community-based group home, and she says he's not in such a rush to leave.

"They were good people and they were kind to Sean, but I don't like that larger setting," Bouffard said about the state facility, one of five in Connecticut. She works as director of Employment Services at The Arc of Meriden-Wallingford, the private group home where Sean has now lived for six years.

Employees for private service providers like Bouffard and legislative researchers for the General Assembly's Program Review and Investigations Committee think the state needs to make a gradual transition from using both public and private service providers for the developmentally disabled, to using just the private, smaller, community-based providers.

"[State-run facilities] are not as personalized as living in a home in the community," Bouffard said. "It's more of a setting that tries to provide services for many people, rather than a smaller setting that provides those same services for fewer people."

Legislative researchers presented recommendations for the state to make the transition on Tuesday at a public hearing. The recommendations follow a Program Review I-issued report in September that said Connecticut has more people with developmental disabilities living in state-run residential facilities than any other state except New York. The cost is up to 2.5 times the expense of contracting with private group homes for the services.

"We can do it as well, if not better, as the public sector for less cost," said Nora Duncan, executive director for The Arc Connecticut, one of the largest private service-providers in the state.

Bouffard's son, Sean, is 37 years old and severely developmentally disabled. He lived at one of the Department of Developmental Services' regional centers for about nine months. Bouffard said he didn't get out into the community as much as he does at the private group home. He's also developed a more personal relationship with the staff in the smaller, more intimate setting, she said.

Quality of care has improved in 17 Connecticut state-run homes since undergoing a conversion to private group homes, said Catherine Conlin and Maryellen Duffy, two researchers with Program Review. They also said 38 percent of DDS-operated homes received citations for not complying with suggested corrections for deficiencies in FY '10, compared to only 13 percent of private homes.

"The quality is not inferior in the private settings, and it could be said to be superior," Conlin said.

"One thing that jumped out at me is the quality assurance when comparing public vs. private," said Sen. John Kissel, R-Enfield, the ranking Republican on the committee. "The private side seems to have more constructs hanging overhead to help remedy deficiencies."

DDS also recognizes that the dual system proves costly, said Conlin and Duffy.

DDS receives about half the total funding for providing 24-hour residential care, but it serves only about 25 percent of the clients in 24-hour care, according to the Program Review report. Private providers have received slightly more funding overall since 2007, but the agencies serve more clients than public facilities and the extra funding doesn't go far enough.

"There does seem to be a lot of low hanging fruit," said Rep. T.R. Rowe, R-Trumbull, the co-chairman of the committee.

Duffy and Conlin said DDS should begin phasing out of providing 24-hour residential care and placing clients in community settings when possible. Not refilling public positions that become vacant and redeploying existing staff to other direct services in the community as opportunities allow will also help transition to private care.

No public employees should be laid off, they said, and can't be laid off - the "no layoff" provision negotiated during the SEBAC agreement this summer keeps public employees safe for four years.

Proponents of public care argue that staff turnover rates at private facilities are too high, however, and that they offer less robust services than state-run facilities. Parents of those at the Southbury Training School, the largest state-run home, sent a letter to the committee in early December.

"We hope legislators understand that former STS residents will still require the same services when they are living in the community-based system and these services will still have to be paid for," the letter said. "To the extent that the residents do receive medical, dental, therapeutic and other services that are not provided under the group home contracts, those services will have to be provided and funded from different sources, such as Medicaid."

PRI researchers didn't recommend that Southbury should close. Rather, residents of the regional centers should look for the "most integrated setting appropriate to the needs of each regional center resident." If the best setting isn't a community placement, staff at public service providers should revisit that decision periodically, they said.