Contact Person: Richard Cohen, Commission Chair Dec. 13, 2005
603-228-0432 ext. 15
For Immediate Release
GOVERNOR LYNCH MEETS WITH REPRSENTATIVES FROM THE GOVERNOR’S COMMISSION ON AREA AGENCIES OVER THEIR FINAL REPORT
Last week representatives from the Governor’s Commission studying Area Agencies met with Governor Lynch to discuss the Commission’s November 2005 report. Created by an executive order by Gov. John Lynch, the commission was charged with identifying the essential operations and delivery systems of NH’s 12 area agencies, which serve people with developmental disabilities, and with recommending ways the agencies can operate more efficiently and cost effectively without compromising services.
The Area Agencies and the Department of Health and Human Services (HHS), which oversees and supervises the system, serves 10,000 children and adults with developmental disabilities. Approximately 6,900 receive limited or periodic services. The rest–3,100, mostly adults–receive more comprehensive services under the federal-state Medicaid funded community waiver programs
The commission found that the Area Agency system has been recognized as a national model, but that funding has not kept pace with increases in enrollment and inflation. The resulting financial constraints have limited services to adults and children with developmental disabilities and have resulted in staffing shortages, waitlists, limited opportunities for employment and community participation, and lack of resources for new initiatives such as quality improvement.
“The data in the report speaks for itself, but behind the statistics are numerous compelling and frequently heart-wrenching stories,” said Commission Chairman Richard Cohen. “While the system as a whole has been remarkably adaptable, cost efficient and innovative over the years, there is only so much that can be accomplished in the face of increasing costs.”
The report’s findings include:
- Starting wages for direct support staff can be as low as $7.00 an hour, with average wages below poverty level for a family of four.
- Vacancy rates of direct support staff have exceeded 36%.
- The enhanced family provider system, the primary residential service model, and the Area Agency system as a whole, has had no general rate increase from at least 1995 through 2005.
- Since 1994, there has been a reduction in average costs of community-based waiver services from $58,000 to $41,000 per person based on 1994 dollars.
- AA’s administrative costs have been reduced nearly in half and Developmental Services within HHS, has had about a one-third staff reduction in the past 5 years, affecting its ability to oversee programs and ensure safety and accountability.
In addition to increased waitlists, the effects of “budgetary austerity” have included:
- Slowed progress in helping individuals find jobs. 1,100 individuals with developmental disabilities are working on average only 13 hours per week, almost all with no benefits. At least 50% of others surveyed by the AA system want to work.
- Increased use of more restrictive and costly settings, e.g. 450% increase in the number of individuals with developmental disabilities at New Hampshire Hospital, even though their primary diagnosis is not mental illness.
- Diminishing AA/HHS/provider infrastructure which has hindered development of new, improved, or more efficient models or methods for oversight and accountability, support and training and program innovation.
Former NH Episcopal Bishop Douglass Theuner, another Commission member, said, “This decreasing capacity of many highly committed people to meet the needs of these citizens is particularly tragic and ironic given that it has come when New Hampshire has prospered and its ability to afford services has increased. The statistics we examined showed that New Hampshire’s ranking in spending for DD services relative to its wealth has dropped from 10th in the nation to 35th from 1996 to 2004.”
Bishop Theuner, Deborah Leonard-Kosits and Cohen met with the Governor last Wednesday to review the findings of the 13-member Commission which examined the AA/HHS system. Kosits, who represented the business community on the Commission, commended the Governor’s knowledge of the system and felt that he was “very committed to developing a collaborative approach in finding solutions.”
“There are approximately 35 recommendations in the report aimed at improving efficiency, effectiveness and outcomes,” said Kosits. “However, the Commission found that there are several recommendations which are of the highest priority, almost pre-requisite to the implementation of the rest.” They are:
- Improved collaboration and community partnership at all levels, including the business community, in increasing employment opportunities.
- Legislative action in the 2006 session to increase direct support staff wages and increasing the enhanced family care stipends which have been stagnant for years.
- Development of a human resources enhancement plan to produce adequate numbers of qualified administrative, professional, and supervisory personnel.
Other high priority recommendations include (a) addressing waitlist issues so eligible children and adults wait no more than 90 days for services, (b) establishment of a central registry of abusers to prevent known abusers from working in direct care, and (c) better use of technology and improved quality assurance and accountability.
Regarding the consolidations of the four regions, the Commission’s report recommended:
- HHS should (a) provide funding for a consultant to assist with the process; (b) allow flexibility in timelines; and (c) provide funding for transition costs.
- External monitoring and evaluation of the merger process to assure that the availability and quality of services are not compromised.
The Full report and Executive Summary are available here.