Accountable Strategies blog

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Posts Tagged ‘Fernald’

Fernald and the folly of unchecked privatization

Posted by David Kassel on January 14, 2008

A bitter battle over privatization is being fought in federal court in Massachusetts.  It’s one that has garnered little substantive media coverage in the state, yet it promises to have lasting consequences for the care of some of the most vulnerable members of society and for the role of government itself in this state. 

The battle is over the fate of the Fernald Developmental Center in Waltham, Massachusetts, the nation’s oldest, state-run facility for persons with mental retardation.  The administration of Gov. Deval Patrick, which is seeking to carry out the former Romney administration’s plans to close Fernald and privatize its services, is appealing  U.S. District Court Judge Joseph Tauro’s ruling last year that Fernald must stay open to its current residents.  

By way of disclosure, I have been working as a consultant to The Fernald League for the Mentally Retarded, Inc., a nonprofit, family-run organization seeking to keep Fernald open.   However, I’ve written this and a previous entry, about how the Patrick administration has politicized Fernald cost-benefit numbers, on my own volition.

I think it’s important to know what’s at stake here and what the state is potentially giving up in closing an institution such as Fernald and very likely the five other remaining state facilities in Massachusetts for persons with mental retardation.  (Administration officials insist they have no plans right now to close any facility other than Fernald, but I think it’s unlikely they would be underaking the expense of this legal battle in the U.S. Court of Appeals if they didn’t have ambitions to close other state facilities as well.)

Here’s what the state and its citizens and taxpayers will be losing if the Patrick administration wins its appeal:

1.  They will lose a long-held state asset—190 acres of land and buildings—in exchange for one-time revenues from developers purchasing the property.  The Department of Mental Retardation has already signed 20-year agreements with a contractor to lease homes in the community for some of the transferred Fernald residents.  The state will not own those properties even though it will be paying up to $2 million per home over the 20-year period

I should note that the Fernald League does not oppose the sell-off and development of most of the Fernald Center campus, and has proposed a “postage-stamp” arrangement under which the current residents would remain in a smaller, designated section of the grounds.  The Patrick administration, however, has declined all offers to negotiate such an arrangement.

2.  They will lose a source of high-quality state-operated care for persons with mental retardation.  This care will ultimately be assumed by contractors, who are more interested in preserving their bottom lines.  This is evidenced by the fact that levels of staffing in community-based, privatized group homes are lower than in state facilities such as Fernald, and by and large community-based staff have little or no health care benefits.

It is this lower level of staffing and lower levels of pay and benefits that are driving the administration’s assertions that the state will save money in closing Fernald.  The problem is that facilities such as Fernald serve individuals with the most severe and profound levels of mental retardation and extensive medical needs in the state.  These people don’t represent the average population in the DMR system, who, by and large, have more mild to moderate levels of mental retardation.  And yet the administration insists, without any explanation, that when these fragile Fernald residents are transferred to the community, they will receive equal or better care there.

 3. They will lose the ability to oversee the care and services provided by the DMR.  In a brief filed in 2006 in the federal court case over Fernald, the Wrentham Association, a plaintiff in the case, noted that DMR’s oversight of the community system is inadequate and relies largely on consumer satisfaction surveys and reviews whose reports are not available until long after the data have been collected.

In addition to eroding the ability of the state to oversee care provided in thousands of community residences, the spread-out community system erodes families’ ability to organize and advocate effectively for their loved ones.  DMR officials have shown that they understand the power of this advocacy.  When families of DMR clients have gotten together to hold DMR to account for its treatment those clients, DMR officials have threatened to evict those clients from their residences and split the families apart.

In its notice of appeal last September in the Fernald case, the Patrick administration stated that the decision to close Fernald is:

…consistent with a national shift away from institutional care in favor of community living.  Decades of research indicate that community settings offer people with mental retardation the best care available and the highest quality of life. 

The first sentence of this statement is true, and the second is false.  It’s true that there has been a national shift away from institutional care in the past three decades.  In state after state, families of residents of state-fun facilities have been fighting uphill battles to save them.  What is false is that the privatized alternative to the facilities provides the best care available and the highest quality of life.

In Massachusetts, the 2006 legal brief filed by the Wrentham Association detailed a privatized system of community-based care in Massachusetts that is at the “breaking point.”  Levels of physical and sexual abuse, medication errors, and outright neglect were far higher in the privatized community system on a per-resident basis than in the state facility system, the brief stated.

It is patently false, therefore, to say that community settings provide the best care available or the highest quality of life.  If that was the case, families of residents in institutions would be clamoring to get those residents out of the facilities and into the community settings.  Instead, they’re fighting to keep them in.  This has forced the privatization proponents to adopt the condescending position that these families don’t know what’s best for their own loved ones.

In June 2007, a Boston Globe editorial, headlined “The Folly of Closing Fernald,” called on the Patrick administration to “stop sparring with a judge (Tauro) whose rulings are consistently in the best interest of the Fernald residents,” and craft “a solution that makes economic and therapeutic sense.”  The administration, however, has chosen not to follow either of these pieces of advice.

Simply because a practice or governmental policy has become a trend doesn’t make it inherently good or right.  As the Globe stated, “deinstitutionalization is not the right remedy for every man and woman with mental retardation, despite the assertions of advocates for group homes.”

In Latin America, country after country have been reversing the privatization trend in recent years, recognizing the economic demage that privatization and deregulation have inflicted on their economies since the 1970s.  Is there really agreement in this country that privatizaton and deinstitutionalization have been uniformly good things?



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Governmental efficiency and the fate of the Fernald Center

Posted by David Kassel on October 11, 2007

In an article in the current (September/October) issue of Public Administration Review, Hindy Lauer Schachter argues that governmental efficency is a political concept.  

Efficiency inolves getting the biggest bang for the taxpayer’s buck–“maximizing the ratio of outputs to inputs” in public administration jargon.  Everyone is in favor of it, and virtually every governmental reform effort has put efficiency at the top of its list.

But Schachter notes that in the public realm:

…political decisions undergird which numbers count, which data constitute benefits, and which are costs.  Governmental efficiency exists in a specific political context.

Reading the article brought to mind a political debate that has been ongoing in Massachusetts over continuing attempts by the then Romney and now Patrick administrations to shut the Fernald Developmental Center in Waltham, MA, the nation’s oldest state-run facility for people with mental retardation.  (By way of disclosure, I have been doing consulting work for the Fernald League, a nonprofit organization of parents and relatives of the Fernald residents, which is fighting to keep the facility open.)

The Patrick administration has put forth an efficiency argument in favor of closing Fernald and ultimately transferring the remaining 180 residents to privately provided, community-based care.  A statement issued in September by the Executive Office of Health and Human Services maintained that Fernald was the most expensive state facility in Massachusetts, with an operating cost in excess of $239,000 per resident, compared with a cost-per-resident of “comparable” community-based care of $102,000.

The EOHHS statement was issued in conjunction with the Patrick administration’s decision in September to appeal a U.S. District Court judge’s ruling that Fernald must remain open to its current residents.

Uising that high comparison cost figure for Fernald may well be a politically effective strategy, given that we are a society in which, as Schachter notes, efficency is a treasured value.  The use of comparison costs appears, on the surface, to take politics out of the discussion.   Whether or not you agree with the political arguments for or against privatization, you can’t argue with the numbers when they’re put before you so starkly.

But do those numbers have any basis in reality?  The EOHHS statement contained no backup or indication as to how the $239,000 and $102,000 amounts were derived.  And yet, the figures were uncritically cited the next day by news media outlets throughout the state.

It’s quite difficult, however, to determine the true cost-per-resident at a complex facility such as Fernald, and potentially even more difficult to determine that type of cost in a sprawling community-based system of services.  For instance, at Fernald, you can’t just take the total facility budget and divide it by the total number of residents to arrive at a true cost per resident.  The reason is that the Fernald budget covers a number of costs that don’t directly or exclusively benefit the residents.  (By the way, the Massachusetts Coalition of Families and Advocates for the Retarded, Inc. (COFAR) filed numerous Public Records Law requests over a period of several months last year in order to get even rudimentary budgetary figures for Fernald from the Department of Mental Retardation.)

Take the skilled nursing facility on the Fernald campus, for example.  The cost of operating the nursing facility, which serves 25 patients, appears to fall under the Fernald budget (although even that is unclear, based on the DMR information that was provided to COFAR).  Yet, the nursing facility is open to all clients of the DMR system, not just the residents at Fernald.  Those 25 patients aren’t even counted among the 180 remaining residents at Fernald.

A couple of other facts to consider, based on an an analysis earlier this year by COFAR of the DMR cost information: Fernald residents share the use of at least 12 buildings on the campus with community-based clients and derive no apparent benefit from eight other buildings.  In addition, nearly 30 buildings on the campus are unoccupied.  Yet virtually all the buildings on the campus are connected to the campus heating and electricity infrastructure.  Those costs are part of the Fernald budget, but should they all be attributed soley to the residents?  COFAR also found out that the $91,900 salary of the director of the Hogan Regional Development Center in Danvers, MA, was inexplicably listed on the payroll of the Fernald Center (See May 2007 COFAR Voice, p. 5).

Then, there’s the whole thorny question of how the administration came up with the $102,000 per-resident for care in the community.  Despite the apparent specificity of that and the Fernald cost number, there is no way anyone can proclaim them as absolutely truthful or even as reliable.  

The Fernald situation demonstrates that it’s impossible to remove politics from cost/benefit analyses of public functions.   Given that reality, Schachter maintains that it’s important to engage citizens and:

…make them more visible and connected to the way political officials and administrators define costs and benefits…Citizen involvement is a prerequisite to meaningful cost-benefit calculations.

I would suggest that at a minimum, citizens need to be informed about the complexities of governmental policies, such as the decision to privatize services for the mentally retarded.  The problem is that when the public administrators justify their actions with simplistic explanations and the press accepts those explanations uncritically, the citizens don’t have much of a chance.

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