Legislative battles looming for Developmental Centers
Data shortage makes expense claims tough to analyze
The future of California’s Developmental Centers is shaping up as a legislative dog fight over budget dollars between the remaining three Centers and the alternative, known as the Community Services Program, which is administered through 21 statewide regional centers. As in most conflicts, an early casualty is truth as partisan politics begin to generate smoke and heat.
At the heart of the matter is the long-term care for 1,043 Californians who require intense, specialized, and mostly around the clock care. They are the most advanced cases of Down Syndrome, severe autism, cerebral palsy, epilepsy and other intensely debilitating neurological conditions that demand highly specialized care and oversight. Over 400 of them live at Sonoma Developmental Center (SDC) in Eldridge.
On March 14, nearly 200 parents and sponsors of SDC residents met with local and state legislators at an annual governmental meeting sponsored by the SDC Parent Hospital Association. Patient guardians spoke passionately for several hours, pleading for the state to continue the level of care that their family members have experienced for over 70 years in some cases.
State Senator Mike McGuire (D-Healdsburg) and Assemblyman Bill Dodd (D-Napa) attended the meeting, along with First District Supervisor Susan Gorin and representatives from U.S. Rep. Mike Thompson, Assemblyman Mark Levine, and State Senator Lois Wolk. Santi Rogers, director of California’s Department of Developmental Services (CHHS), which is overseen by the California Department of Health and Human Services, was there along with SDC’s Executive Director, Karen Faria.
There has been a nationwide push since the mid-1960s to close large group homes for the developmentally disabled – a catch phase that covers a host of severe mental and physical conditions. Many people formerly housed in these centers have successfully transferred to community settings and enjoy much greater freedom of choice and action than the large group homes could provide. Their ongoing needs and supplemental support are overseen by 21 Regional Centers throughout the state.
California has already closed two of its five major developmental centers since 2009, but the question today is, can the community care settings that work so well for many provide adequate or even safe havens for the remaining people who require such a high level of care?
About the only thing that is clear is that the current configuration of the remaining Developmental Centers will have to change going forward. Both were built to serve much larger populations and have rapidly failing infrastructure from years of neglect and lack of funds. Both also occupy large tracts of extremely valuable real estate. Sonoma’s Center sits on just under 1,000 acres of prime land in the heart of Wine Country. Fairview sits on 750 acres in Costa Mesa, between Huntington Beach and Newport Beach.
Several bills were introduced in Sacramento in February by members of the Republican Caucus aimed at closing the SDC by December, 2018, and transferring their $500 million budget allocation to the regional community home operations.
Another, less partisan bill, co-sponsored by Sen. Lois Wolk, would substantially lower the ability to audit private service providers as well as mandate a two-year waiting period to audit upon demand.
State Senator Jeff Stone (R-Murrieta), wrote, “These so-called developmental centers currently house approximately 1,000 people with disabilities in them, at an annual cost of over $500,000,000. That amounts to $500,000 per patient, whereas regional centers spend an average of $17,000 per patient and deliver the kind of support that help the developmentally (sic) thrive in their own communities.
“By shutting down these large and outdated state institutions and shifting the money to regional centers, those in need of state services will receive better care and more support. Taxpayers will also be well served by having their money spent in a more efficient and transparent manner,” Stone’s press release announced.
Figures like these are anathema to parents of DC residents. “What these people are ignoring is that most of the community setting clients are living at home and are cared for by their parents or relatives,” Kathleen Miller said, noting that many of these clients may have mild autism or have much less severe developmental disabilites than SDC residents. “That’s about 70 to 80 percent of the 260,000 number they are quoting.” Miller is president of the PHA and has a son at SDC.
Stone’s office could not point to a particular section of the current budget where they came up with the figures, but something close to those numbers can be derived when the total Developmental Centers budget of $500,000,000 is divided by the remaining 1,000 residents. On the other side, dividing the Regional community care budget of $4.8 billion by 260,000 yields a per person dollar cost of about $18,4500.
Miller, McGuire and others point out that the low-ball figure in no way reflects the cost of the level of care needed by today’s remaining DC residents.
“Senator Stone’s bill puts politics in front of quality of care of a resident,” Sen. McGuire said last week. “His discussion can’t just be about the financial bottom line for the most medically fragile residents in the entire health services system.” McGuire feels the major issues to be resolved in ongoing health care issues is the ‘continuum of care’ analysis that examines outcomes – how well the system does what it’s supposed to do.
“The federal government is no longer going to fund … programs with poor outcomes,” McGuire said. “What the state wants is higher outcomes for individuals in group settings, like the Sonoma Developmental Center or its foster homes.”
McGuire’s comments reflect concern over the status of millions of dollars in federal funds now being withheld from SDC because of low quality care in four of its Intensive Care Units. That status will be reviewed in May.
Nowhere do the various health agency budgets break down actual care costs per individual served. According to the available budget figures, it takes 4,700 people to staff the DCs, while the Regional Centers require only 106 people to administer services to its population of 265,000. How many more people are actually required for community services and how those costs are funded is not readily apparent from the budget documents.
Supervisor Susan Gorin heads up a local coalition of government and private agencies working on SDC’s future. “We are trying to create a different way, not necessarily closure, but work with the state to continue to provide services for individuals who may not do well in community settings,” she said. “We are looking for places on campus that might accommodate (special) homes operated by Regional Centers. That is going to be a significant challenge. Where are those homes going to be located? Everybody has agreed to work together to develop a solution, not necessarily a continuation of the Sonoma Developmental Center we’ve known or discrete homes in neighborhoods throughout the county.”