DISABLED CARE: Wilson Administration Feels Heat To Reform Programs
Gov. Pete Wilson and his administration are under "intensifying" pressure from "federal investigators, state auditors and grassroots groups" who contend that "promised reforms" to improve care for the "developmentally disabled" have not gone far enough, the San Francisco Chronicle reports. Wilson heard warnings last month from the Health Care Financing Administration that the federal government will cut $250 million in Medicaid funds "unless continuing threats to the well-being of the disabled are addressed" by June. At the state level, a report issued by state Auditor Kurt Sjoberg last week "ripped" the governor's Department of Developmental Services for "failing to follow state law in the oversight of state- funded regional centers for the developmentally disabled." Advocacy groups statewide charged at a Sacramento protest last month "that Wilson's proposed $175 million budget increase for disabled services is deceptive because it offers little or nothing to most community agencies that provide housing, rehabilitation and other programs." The Chronicle reports that all this "criticism comes as the governor and legislators struggle to reform the system that provides care for 150,000 Californians with varying degrees of mental retardation, cerebral palsy, autism and other developmental disabilities."
The March 27 letter threatening to cut off $250 million in Medicaid funds was only the most recent warning HCFA has issued to the Wilson administration. In a year-long investigation of disability care provided by California's hospitals and community programs, HCFA found "severe deficiencies." Referring to investigations of care in the North Bay area, HCFA officials most recently wrote that they were "disappointed to find the same types of deficiencies as those found during our reviews last summer." The biggest problem was caregivers receiving only a minimum-wage salary, a fact that often leads to high staff turnover, which "compounds health and safety risks" for disabled patients. But Clifford Allenby, director of the state development services agency, "was optimistic" that the state would meet the June deadline for improvements. "I think we're working through the problems and we are making good progress. I really do expect us to work this out," he said.
While Wilson proposed a 10% increase for disabled care in January, critics say the increase does not "effectively deal with the problems." One of the biggest critics is Sjoberg, whose audit found that the developmental services agency "failed to comply" with state law requiring "closer oversight of the regional centers." Sjoberg said that while "the state dispenses $1 billion a year to the regional centers, it does not closely track the centers' spending or the effectiveness of programs they oversee." Thus, the "department cannot ensure that all developmentally disabled people ... have equal access to and receive the same level" of care. However, Allenby said some of the criticism is "unfair." He said the department is already "implementing changes to comply with the law," while future efforts "will address the need for closer monitoring of the regional centers and programs for the disabled."
The Chronicle reports that community care providers are "nettled" by the Wilson administration's move to apply stricter oversight of local programs. Closer monitoring does not help a problem caused mostly by lack of money, they argue. "I'll admit there are some providers who do not do a good job and are not nice people," said Contra Costa ARC director Barbara Maizie, "but we're talking about the other 95% who try to do a good job and are struggling to survive." The average salary for direct-care staff remains at poverty level (about $14,000 a year), making the annual turnover 100% or higher, say critics. When Wilson offered no increase in his budget for caregivers for the ninth year in a row, he "certainly wasn't thinking about the needs of community groups and the developmentally disabled population," said state Senate President John Burton (D-San Francisco). But Douglas Arnold, deputy director of the developmental services department, said the budget "was built to address the demands of federal investigators."
Time To Catch Up
While the Wilson administration is mindful of the criticism from all three fronts, the Chronicle notes that what "remains to be seen is how much reform they're willing to buy." Thirty-five million dollars in new funds for "employment, education and rehabilitation programs" have been promised by state Sen. Mike Thompson (D-St. Helena), the state "Legislature's point man on developmental services." And the Wilson administration says "more money may be offered in the weeks to come." But California Rehabilitation Association lobbyist Dwight Hansen says the $35 million is "really just a status quo amount. It allows the care providers to continue doing today what they were doing yesterday." The actual price tag for substantial improvements could be $150 million, according to Hansen. "Because of the number of years involved when there has been insufficient funding, the dollar figure it takes to really fix things is significant," he said, adding, "There's a lot of concern that the number is so big that it may be a difficult thing for the Legislature to do" (Lempinen, 4/20).