Regional Centers will take over from SDC
A conversation with North Bay Regional Center Director Bob Hamilton
From the day they learned that Sonoma Developmental Center (SDC) was to be shuttered, the parents and loved ones of those who live there have been anguished over what will happen to their charges. They have made it abundantly clear that they do not expect SDC residents to receive the same level of care they have enjoyed at the 125-year-old institution situated on a thousand acres of lush Sonoma countryside outside of Glen Ellen.
“Some people think we are the devil,” Bob Hamilton said, smiling but semi-serious. Hamilton is executive director of the North Bay Regional Center, one of California’s 21 privately run regional centers responsible for administering care to the vast majority of developmentally disabled people in the state.
Hamilton, a Kenwood resident for many years, is past retirement age but continues to put in well over 40 hours a week doing his job, which he is passionate about.
“This is a joy, a labor of love. I would not do it otherwise.”
Hamilton has a cousin who was born with Down Syndrome. The parents had to decide whether to place him in an institution.
“The parents at SDC who made that decision are having to re-live it,” Hamilton said. “I feel for them in that regard. “That’s a tough burden. I try to help them feel good about it. It’s not easy.”
Every person who qualifies for funding under the developmentally disabled laws is administered through the Regional Center system, even those domiciled in the state’s few remaining institutions like SDC. All of those institutions will be closed pursuant to federal policy and the residents moved to smaller homes scattered throughout the state, called community settings.
“Very few people in the general public know about [Regional Centers],” Hamilton said. “We have been on a public information campaign for a couple of years, making an effort to get our name out there.”
Regional Centers are brokers.
Under the state model, clients ranging from the giant Becoming Independent to single, mom-and-pop-run homes, are funded and overseen by Regional Centers.
“We broker 90 percent of our services to the community.” They oversee all the details of housing, staffing, and supplying the needs of over 800,000 developmentally disabled people throughout California. The North Bay RC covers Napa, Sonoma and Solano counties, overseeing thousands of clients, with over a thousand in Sonoma County alone. In Sonoma, Becoming Independent is the largest provider of services, with over 600 clients and a $14 million annual budget.
The NBRC has an annual budget approaching $200 million, half of which eventually comes from federal sources, mainly the Centers for Medicare and Medicaid Services. “They provide funding to any state that will provide services to keep folks from being institionalized,” Hamilton said.
As with most state issues, money is at the heart of what is happening to developmentally disabled programs. Developmental centers such as SDC are being shuttered because of the high per client cost and a demonstrable federal animus toward large institutions. Large or small, all developmentally disabled programs have taken a billion dollar funding hit in the past 10 years, starting with the 2007 recession. That money is just beginning to be restored, with an additional $300 million being added back in next year’s budget (not yet approved). Who gets what has not been decided, although much of the funding will be earmarked for expanding just the administrative services needed to manage moving these clients over the next few years.
Hamilton said that his providers – the people who run the care facilities – have caps on how much they can pay their caregivers, caps so low they are competing with fast food workers in areas that have $15 minimum wage laws. SDC workers are for the most part state employees who enjoy much higher pay levels and benefits than those in the private sector. Part of Hamilton’s job, as well as the other Regional Center heads, is to get more money freed up to pay for better help.
“There is a lot of funding effort underway to increase the quality of pay for caregivers,” Hamilton said. “It has been an issue at SDC. The perception is not unfounded that [SDC employees] are better trained and better paid, but not necessarily giving better care. Most [Regional Center employees] are dedicated, and couldn’t do what they do for maximum money. Many have degrees in social work, psychology, and other human services. They want to help people. It’s pretty common in the industry.”
But taking federal money comes with its own set of issues.
“There are a lot of strings with fed money,” Hamilton said. “There is a lot of reporting which takes a lot of time from case managers who could be working with families.”
The patients remaining at developmental centers tend to be some of the most fragile in the entire system and will require special homes, care and treatment not always available in general community settings. These homes must be built and staffed by the end of 2018 to meet the current timetable, which Hamilton doesn’t think is any too realistic.
“That’s the $64,000 question,” he said. “We will move heaven and earth to get facilities and programs ready, but we are not going to push clients out of the SDC if they are not ready. It’s a client-centered concept.”
Just moving clients out of the SDC to a private home is difficult and can take up to a year, Hamilton said.
“As the population drops, care at SDC is going to be more difficult to maintain. They will have to consolidate units, [a temporary] move for a client that can take six months adjustment. And you can’t move anybody in who is in crisis,” he noted, typically those with behavioral issues.
Moving clients also involves determining what the client wants and what their guardians want, as well as what’s available.
As for building new, smaller care homes at the existing SDC campus, Hamilton thinks that upgrading the aging and exhausted infrastructure would be prohibitive. But a clinic or other support services would be more likely. “That way you wouldn’t lose the doctors and clinicians or the staff.”