Connecticut’s agency for serving people with intellectual and developmental disabilities runs five campus-style centers that on average cost more than Southbury Training School and twice as much as privately-run alternatives.
The Department of Developmental Services regional centers – located in Meriden, Newington, Norwalk, Stratford and Torrington – care for people with greater needs. The federal government designates the facilities “intermediate care facilities for individuals with intellectual disabilities” or ICF/IID so the state is reimbursed for half its expenses.
“One has to be cautious in engaging in general comparisons,” said DDS spokeswoman Joan Barnish. “They are a very diverse group of residential settings. Some have significant nursing and behavioral supports with high staff ratios and others have lower staff ratios and far less clinical supports.”
“While there are some differences there is no question that private community settings cost far less than residential settings operated by DDS for people with similar needs,” Barnish said.
“Regional centers have nursing available all the time; this is true of some but not most community settings,” she said. “A small number of the individualized campus units serve people with very special needs that are not typical of the community settings.”
The Southbury Training School has received extensive media attention for its high costs and legal battles. A 2012 report issued by the Program Review and Investigation Committee found that, adjusting for need, Southbury does cost more than regional centers. The report found Southbury costs twice as much as a private alternative for the same level of need, while the regional centers cost 1.8 times as much as private providers.
The same report found private providers paid direct-care workers an average of $15.53 an hour, while DDS paid an average of $24.24 and offered benefits worth about $40,000.
According to department cost estimates submitted to the General Assembly for fiscal year 2012, the average cost per client at Southbury Training School was $329,614 while the cost per client at the regional centers averaged just over $400,000.
DDS pays a privately-run ICF/IID $159,788 on average per resident, about half the cost of a Southbury resident and 40 percent the cost of a regional center.
Unlike the PRI report, these costs do not adjust for level of need.
Barnish said the agency is primarily serving people with at home or in the community, so “the state is not pursuing expansion of public or private ICF-IID settings.”
DDS has a list of more than 1,000 people seeking services, although only a portion are seeking the level of care available at ICF/IIDs.
For every regional center resident transitioned to a private provider, the agency could afford to serve another person with a high level of need or multiple people with lesser needs.
A 2008 report by the Program Review and Investigation Committee found costs at Southbury and the regional centers to be very close at the time, with costs per client per day of about $800 in 2007, up from less than $600 in 2002.
Over the same time period, private provider rates per client per day rose from about $350 to more than $400.
In 2012, the per diem rates were $1,096 for the regional centers, $903 for Southbury and $437 for private providers, according to the DDS estimates.
The 2012 PRI report provides a more detailed look at daily costs over recent years. It found Southbury’s costs fell by 1 percent between fiscal years 2009 and 2011. The West region’s costs rose 5.6 percent, but were the lowest of the regions at $779 per day. The North region went up a similar amount, 5.3 percent, to $1,000 a day.
The South region’s costs went up 11.5 percent, reaching $1,362 per day.
None of these cost estimates adjust for levels of need.
According to the 2012 cost estimates, 414 people lived at Southbury Training School, 211 at the regional centers and 407 at private ICF/MRs.
“The trend of services in Connecticut over the past 25 years has been an increasing reliance on private providers. Over the last 10 years there has also been funding of supports to assist people to live with their families or more individualized person centered settings,” Barnish said. “There has been a corresponding trend of decreased reliance on DDS operated residential settings.”