Hundreds of seriously disabled individuals have over the past two years been moved from large, state-run institutions to group homes, family dwellings, and other community residential settings as part of New Jersey’s controversial plan to ensure these individuals live in the least restrictive environment possible.
But a state review of 40 cases released last week revealed several troubling situations involving patient care, record keeping, and problem solving. One person was left without a properly functioning wheelchair for the better part of two years, severely restricting the individual’s ability to participate in regular activities, and another was fed milk and hard food, including pretzels, despite being lactose intolerant and at risk for choking.
On Friday Democratic legislative leaders expressed concerns about the findings, conducted by state auditor under the nonpartisan Office of Legislative Services, and called for a follow-up review later this year. Senate President Steve Sweeney (D-Gloucester) and Majority Leader Loretta Weinberg (D-Bergen), have led several efforts over the years to ensure these clients are receiving proper care in their new community homes.
“We want the OLS auditor to take another look in six months and we want the acting commissioner of the Department of Human Services to keep us informed on what corrective action is being taken and how the situation is being monitored,” Weinberg said. “This isn’t a problem that can be ignored.”
The relocations have long triggered concerns — and prompted legal actions — for some disability advocates and relatives who fear these community settings are not fully equipped to care for patients with significant medical, physical, and social needs. But state officials have insisted the smaller, less-institutional dwellings are both more appropriate and legally required under a 1999 U.S. Supreme Court decision known as the Olmstead case.
According to the audit, more than 100 residents at the state’s five institutional developmental centers were still awaiting relocation, as of February. More than 400 individuals have already been moved from these facilities and two others that the state closed, Totowa’s North Jersey Developmental Center (July 2014) and the Woodbridge Developmental Center (January 2015).
As of October, the state’s Department of Human Service’s Division of Developmental Disabilities cared for some 23,400 clients with issues that include intellectual disabilities, autism, cerebral palsy, epilepsy, spinal bifida, and other impairments; the vast majority are now in community residences, with only 1,600 still living at Developmental Centers.
[related]The audit examined 40 purposely chosen cases — 20 from Woodbridge and 20 from the Totowa facility — to determine if the state followed its own requirements for creating a transfer plan, properly monitoring residents in their new community homes, and documenting and fixing problems as they occurred.
State monitors were often weeks late in completing scheduled visits with many clients and more than half endured problems — ranging from a lack of equipment to missing paperwork — that were not resolved quickly, the auditor found. Other individuals were moved without a proper checklist of their special needs, or a plan for their daily activities or recommended behavior modifications. At times, clients missed medical appointments or recreational programs as a result of documentation gaps.
In a written response to the audit, acting human services commissioner Elizabeth Connolly said the department “generally agrees with the OLS recommendations and concurs with the findings of the audit.” Connolly also explained that the files didn’t always include full explanation of a behavioral incident or other situation that might have caused a resident to miss outside appointments with doctors or program staff, or the reason a caseworker’s visit was delayed. In the future, staff would add more detail, she said.
Representatives of the group home industry also expressed concern about the audit’s findings and promised to use the results to help improve operations, according to NJ.com. The transfers began in 2013, when Gov. Chris Christie’s administration settled an eight-year-old lawsuit filed by Disability Rights New Jersey, an advocacy group that claimed the state was not living up to the requirements of the Olmstead decision.
Weinberg, who has pushed for greater state oversight of the relocation process, noted that the problems discovered in the audit were issues that advocates had warned about over the years. However, she agreed the report should be used “as a productive tool to make improvements that serve the needs of the clients, employ best practices for group homes and further the goals and objectives of Human Services officials.”
Sweeney, another longtime advocate for the residents and their families, noted the move to a group home is “a disruptive transition under any circumstances for those with developmental disabilities,” and the state must ensure that clients are protected in the process. “It is important that the follow-up care and monitoring of their living conditions and the care they receive is done well. They shouldn’t be left vulnerable to problems that can have an adverse effect on their health and wellbeing,” he said.