Services include early intervention and pre-school, high school career counseling, job placement, residential services, recreation and guardianship.

Promoting Service Delivery Sustainability through Policy Change: Opportunities in FY13

Proposed midterm Budget Adjustments at DDS for FY13 reduce private residential funding by $24 million and nonresidential funding by $14 million. The DSS proposed Midterm Budget Adjustments for FY13 reduce room and board payments for residential services for individuals with intellectual and developmental disabilities in both ICF/MR & CLAs. The reduction is approximately $4,400 per year per bed and impacts CIL homes with reduced/eliminated mortgage payments.

DDS is very clear that there will be a disruption of services to individuals and families through delays and slot reductions and that there will most certainly be a destabilization of the provider network which has gone years without a COLA, experienced 5 years of frozen room & board rates and faces additional cuts from DSS. Flat funding in the face of extreme increases in energy and food costs, an unprecedented slump in the economy and reduced charitable and foundation giving have already forced workforce reductions and delays in much needed repairs and maintenance to homes. Even for the CIL homes, the savings from annual rent and mortgages were anticipated to help provide an opportunity to catch up on delayed maintenance and repairs to ensure regulatory compliance.      

Waiver and licensing requirements prohibit reductions in health and safety, as they should. However, the private nonprofit sector has nowhere left to turn to reduce costs that do not impact health and safety, compromise the quality of housing or force out-right closure. All homes will eventually need capital repairs such as new roofing, siding, sprinkler maintenance, furnace replacement and driveway repair. The costs for residential services for CLA and ICF/MR homes are already half of what the public sector costs are, with quality that rates higher, for the same services. The Legislative Program Review and Investigations Committee staff finding, published on 12/20/11, is the most recent of many of reports to illustrate that in the last decade.    

Here is just a small sampling of real world data from ICF/MR and CLA providers to help illustrate the reality of the situation and which is reflective of the situation state-wide. 

From a nonprofit organization operating 11 CLA’s that has recently seen a decrease in interest expenses between FY10 and FY11, but saw a net increase in overall costs of $14,000 due to mostly to these factors:

•    Utilities increased an average of $700 per home per year. Most homes have oil heat and are subject to volatile price increases.

•    Repairs and Maintenance on the homes increased by an average of $2,100 per home. Part of this increase was the effect of the extraordinarily bad winter which increased snow removal costs significantly in the past year.

•    All homes must receive routine maintenance on sprinkler equipment, boilers, security monitoring, septic service, etc. There is a reasonable expectation that homes will be kept in good repair and in compliance with licensing regulations, but no allowance in the room and board rate for the increased cost of contracting for such services.  

•    Food costs increased by an average of $500 per home. A home with 6 residents is expected to spend no more than $290 per week, which is only $7.00 per day, per resident for all food and household items. As an additional challenge, some residents are now on restricted diets which increases the overall food cost. It is difficult serving these types of needs under a rate freeze.

From a nonprofit organization operating 2 ICF/MR’s and 1 CLA:

•    After losing almost $90,000 three years ago, 4 managers were laid off and additional cost cutting measures were instituted, such as direct purchasing from slaughter houses, creative bulk purchasing programs and contracting with third party energy suppliers. 

•    As a result, FY09 ended with a surplus of less than $2,000, FY10 ended with a surplus of less than $5,000 and FY11 was a break even year. There is simply no room to cut.

It is important to note that the employees of these organizations face the same increased costs and concerns at their own homes as the service providers do. Many providers have been forced to reduce hours and freeze wages, all while the threat of layoffs loom. The economy is certainly tough for most Connecticut residents and nonprofit organizations, the safety net for our state, know that better than most. However, that neither makes it easier to explain or accept the fact that hard working nonprofit employees have salaries that are often half that of their state employee counterparts in identical jobs:  jobs that come with both cost of living and step increases, as well as the promise of no layoffs for several years.  

There is a fiscally and socially responsible alternative to further cuts to the private system of care.  The comprehensive findings of the 12/20/11 Legislative Program Review and Investigations Committee report on Provisions of Selected Services for Clients with Intellectual Disabilities highlight, again, that the private provider system of care offers services that are at least as good as those offered in the public system at significantly less cost.  In a time of shrinking resources and rapidly growing waiting lists, Connecticut has an opportunity to move more quickly in a direction that transitions humanely from an antiquated dually operated system to a private system of care while deploying DDS employees to fill vacant positions in other needed areas.  The state would be in a position under these circumstances to reduce overall costs while still increasing funding to the private nonprofit providers that are able to flexibly respond to the needs of individuals and families, reduce waiting lists, offer incentives for professional development and create meaningful employment opportunities for individuals with intellectual and developmental disabilities through social enterprise and collaborations with private entities.     

Connecticut policy makers are encouraged to support changes that protect and enhance services for individuals and families, reduce waiting lists, ensure that the services provided by public employees are as valuable and efficient as possible and adequately fund the private sector so that it can responsibly serve both its consumers and its staff, all while  ensuring the long-term sustainability of services in Connecticut.

Please contact Nora Duncan for more information:  (860) 246-6400 or nduncan@arcofct.org.