Caring for the disabled

Caring for the disabled

June 20th, 2011 in Opinion Times

The Tennessee Department of Intellectual and Developmental Disabilities is a relatively new agency confronting an old problem. The department, responsible for providing service and support to residents with intellectual disabilities, had to find a way to fulfill its mission within a shrinking financial framework.

The DIDD, until recently a division of the Department of Finance and Administration, had to cut $48 million in spending for the upcoming fiscal year. Commissioner Jim Henry and his staff have crafted a budget they say will provide adequate services to the largest number of department clients. For the most part, they seem to have done so.

Most of the department cuts will come in two areas- personal services and nursing services. The former provides hands-on care that helps families keep loved ones at home. The latter delivers skilled care, generally by a registered nurse. Those services are expensive, Henry said Friday at a meeting of the Chattanooga Times Free Press editorial board.

Currently, 27 severely disabled patients in the state are served by two personal assistants each day. In essence, the state provides around-the-clock assistance for those patients at a cost that is sometimes more than $230,000 a year per person. About 1,900 additional clients are served by a single personal assist daily. The price for that service is high, as well.

Henry says skilled nursing services cost up to $300,000 annually for some individuals who need 24/7 care. The department's new budget will reduce both personal assistant and nursing services. It limits nursing services to 12 hours a day and personal assistance services to 215 hours per month.

That seems to be a reasonable compromise given the state's fiscal difficulties. The cut in services will save the department money, and it should not place an overly heavy burden on the families of most clients. Many receive additional home health services through their TennCare Managed Care Organization.

The reductions, Henry admits, could prompt major changes. The cuts might compel some families to seek alternative care for their loved ones. The DIDD is ready to assist. It will employ a growing network of small and medium-sized community-based group homes to serve those who can benefit from such an option. That, Henry rightly says, is a far better and more fiscally prudent option than warehousing individuals in large institutions.

Cutting the budget for the upcoming year wasn't the only issue DIDD must address. At least three additional problems confront the department. All demand extensive planning, and each likely will require significant funding in the future.

The DIDD has a waiting list of about 8,000 people, roughly the same number it currently assists. Reducing the list won't be easy. Some communities are well served - Henry cited Orange Grove here as a successful model - but others, particularly in rural areas, have no providers at all. The DIDD will find it difficult to rectify that situation.

The department also must prepare to help more clients. Experts agree requests for DIDD services will skyrocket, fueled in the main by individuals with autism. Finding the expertise and money to meet the demand will be hard. Tackling those issues is next on Henry's agenda.

For the moment, though, attention should be focused on changes starting July 1 at DIDD. There's no certainty things will go as planned. Programs should be carefully monitored to make sure that there is no adverse effect on the health, safety and welfare of individuals dependent on others for assistance, and to make sure that the changes don't unfairly shift the cost of care from the state to individuals or to local communities.