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Community-based programs no panacea

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Monday, Sep 01, 2008 - 12:14:55 am CDT

Family members of developmentally disabled Nebraskans delivered a powerful message last week to a legislative committee.

Community-based programs are no panacea.

In fact, community-based programs can be just as dangerous, abusive and neglectful as the deplorable conditions documented by federal investigators at the Beatrice State Developmental Center.

Sandra Ham told the committee about repeated instances in which the safety of her teenage son was jeopardized by the people supposedly responsible for his care in a community-based program.

In one instance, a staff member was stopped for drunken driving with her son in the car. In two other incidents, her son left a community-based program. Once, he was taken into custody by police after a disturbance. The staff member responsible for the home’s clients was asleep. In the other case, he was found far from home with the help of police and news media.

Her son is now at BSDC, where Ham feels he receives better and more appropriate care.

The state of Nebraska currently is working to reduce the number of residents at BSDC by transferring them to community-based programs. By right-sizing the chronically understaffed center, state officials believe, the level of care can be improved.

The shift from large institutions such as BSDC to community programs is supported by the federal government and many professionals. Mary Angus of the advocacy group ARC of Nebraska told state senators that the Beatrice center is an “outmoded, outdated institution” that remains open for political reasons.

Given the abysmal record of care at Beatrice, documented in multiple reports from several different sources, as well as the target of lawsuits, the need to place more residents in community-based programs seems necessary.

Testimony on the lapses in community-based programs, however, drives home the point that as the shift is made, the state needs to maintain strong oversight in order to ensure that the predicted improvements in care actually take place.

State senators and Gov. Dave Heineman should recognize that providing the level of care these vulnerable Nebraskans deserve might require more money.

Alan Zavodny of Northstar, which serves clients in 22 counties in northeast Nebraska, pointed out last spring, “We don’t want to shift the problem from Beatrice to the communities. Our employees receive $2 a hour less than those at BSDC. So we have a lot of trouble recruiting and retaining employees.”

The Legislature this spring wisely widened the special investigative committee’s scope to include community-based programs. The committee appears to be on track. Let’s hope the message is getting through.


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russell wrote on September 1, 2008 8:19 am:
" It always amazes me when persons expect first class service but will only pay 2nd class fees (if not completely free) when it comes to health issues. We see this in discussions of medicines, hospitals and, especially, health insurance. How many times have each of us heard "my health insurance is too high" ? So everybody is searching for the lowest cost without regard to the humans that provide that service. In other words the staffs at medical facilities and research centers cannot be paid entry level wages. "

 peb wrote on September 1, 2008 9:11 am:
" Can't there be both? Community-based for those who function at a higher level and institutional care for those functioning at a lower level. Or in home care for those that would like that? It seems the state is, at its constituent's expense, and as usual, trying to save money. "

 Pro wrote on September 1, 2008 11:53 am:
" If the community-based programs had been subjected to the same level of scrutiny as BSDC was, then HHS would have a much more severe scandal on its hands than it does now. The community programs have moved in tandem with BSDC over the past twenty years: from national model to national mediocrity, disgrace, and worse.

One factor is that the supervision of both was transferred from the Department of Public Institutions to HHS about 12 years ago, when HHS consolidated three government agencies inton one. The CEO of BSDC, under DPI, was a semi-autonomous leader with broad authority for funning the facility. Under HHS, the CEO has almost no authority; all authority is vested in an unresponsive but micromanaging bureaucracy in Lincoln.

Another factor is that the governance of community programs was shifted from quasi-governmental regional governance in which the counties played a vital role, to HHS in state government, again about 15 years ago. This meant that community programs no longer had to be responsive to local leaders; instead community programs were responsible to ... you guessed it: an unresponsive, but micromanaging bureaucracy in Lincoln.

I have never--not once in the last 20 years--seen any evidence that HHS has any interest in running a program at a national leadership level. This lack of vision and energy is still another factor in the loss of vitality of our services for developmentally disabled citizens.

The absolute malaise exhibited by HHS in its management of DD programs (and of most programs under its control)coupled to a management culture of non-accountability is the chief cause for the current BSDC scandal and will be the chief cause for the brewing scandal in community-based services for DD persons. "

 Darwin wrote on September 1, 2008 4:36 pm:
" People expect paid strangers to treat their "loved ones" better than they do themselves. Hey, wake up! You want your kid/mom/grandpa to be treated the way you would treat them? Then YOU TREAT THEM!

I dont think you want to deal with your kid's mental problems, or change your grandma's catheter, any more than the nurse down the block does. Stand up and take some dang responsibility for your family. Here is a crazy idea... If you are adult enough to have a kid, you are adult enough to be responsible for its care. The State isnt responsible. Nor are your fellow tax payers. And, crazilly enough, that guy you hire to look after grandpa doesnt really care about him. It is a job. And not a good job either. "

 Katua wrote on September 2, 2008 12:01 pm:
" I agree with peb. There needs to be both "institutional" settings as well as community based. I have personally worked in both settings so I am familiar with how they work. In my experience, (for the most part) the individuals in "institutions" get far better care than the ones in the community. Not to say that people in community-based programs get bad care, it's just not up to the same standard. I believe this happens for a couple of reasons: one, staff who work in government based programs are paid more; and two, in general, the training is more extensive. When I started in the community based program, my training consisted of following around a current staff member for a couple of days then I was on my own. Whereas when I went to state funded, I recieved extensive training and still recieve on-going training.

Also, I do have to say, for the most part, the workers in the facilities (whether it be community or state) DO care about the individuals they serve. If they didn't they wouldn't be in that field. I could make a whole lot more money doing something else but I still choose to work in this field because it is my passion. That is how nearly everybody in this field is. "

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