The recently announced closure of several group homes and shared living placements operated by the United Arc demonstrates a fundamental weakness in provision of services to our vulnerable citizens. The majority of services provided by agencies like the Departments of Developmental Services or Mental Health are run by corporations through contracts with these agencies.
This purchase of service system was largely a product of deinstitutionalization. It was supposed to make the creation of new programs easier by shedding the archaic and burdensome controls that exist when the state provides services. By having a variety of locally based providers, it was hoped that competition for contracts would stimulate creativity and responsiveness to local needs. Many of the providers, like the United ARC, were previously local advocacy groups that expanded into directly providing services. The existence of local volunteer boards of directors also expanded the base of political support for the mission of caring for these clients.
While some of the benefits of the purchase-of-service system have been realized, there is a steep downside to this paradigm. First, it reduces accountability. State agencies can absolve themselves of responsibility by passing blame onto obscure providers when, inevitably, serious problems arise that may be more related to systemic issues than provider mistakes. Delivering these services through private providers makes these operations more opaque. These providers are not subject to the Freedom of Information Act; the meetings are not subject to the open meeting law.
At its core, the growth of the purchase-of-service system was an attempt to save money and reduce the role of unions in state human services. A major valid point made by advocates was that community-based services could deliver better service at a cheaper price than institutional services. Unfortunately, one way that savings could be made was through lower rates of compensation and reduced fringe benefits for direct care staff.
During the late 20th century, as institutions were being closed and replaced by community-based provider services, the pressure to reduce staffing costs became irresistible. During a period of transition from an institution-based system to a diffused community-based system, bureaucrats and legislators were burdened with trying to balance budgets that included continuing costs of institutions, and the start up costs of new community programs. Add to that the competition for contracts and the downward pressure on staffing costs was inevitable.
This downward pressure on staffing costs in vendor services has had serious negative effects on the quality of services. With little or no pensions or staff development incentives, vendor programs are plagued by high turnover. This makes consistent programming and assurance of quality more difficult. When unemployment is low, vendors are desperate to maintain staffing levels. The “espirit de corps” and commitment necessary to do this very difficult work is hard to maintain in this environment. There are, of course, wonderful exceptions but any large system that relies on the exceptional dedication and heroic sacrifice of its essential workforce is bound to have major failures like the collapse of the United ARC.
The state bureaucracy will claim that the recent decision to terminate the United ARC’s contracts proves that the system works. This is just not true. The problems with the United ARC did not happen overnight. Discerning individuals with regular contact with the ARC could see that they had problems. Luckily, my one client in a home share placement was insulated from these issues by the long term dedication of his home share providers, one for 18 years and another for the past five years.
As an attorney advising aging parents with adult children who are clients of the Department of Developmental Services who cannot live at home, I recommend they consider placement in a state-operated group home rather than a vendor-operated home. The staff in these state-operated homes have stable jobs, good wages, regular pay increases, a fixed benefit pension, excellent health care, sick time and family leave policies. As a result, staffing is stable, programming is consistent and oversight and accountability is direct and transparent.
I am not recommending that the vendor system be replaced by state-operated programs. What I am recommending is a permanent statutory commitment that the compensation and benefit packages for direct care staff in vendor programs be the same as state-operated programs. Further, that staff retention and development be a priority in the awarding and oversight of vendor contracts.
I am a local attorney who specializes in legal issues of people with mental challenges. I am a former Director of Quality Assurance for the former Department of Mental Retardation, now the Department of Developmental Services.
David Roulston lives in Greenfield.