GOOD BAD WORST

Stockton Record
Editorial
December 10, 1997

Don't fail to meet the needs of the disabled

In a war of words between Washington and Sacramento, the quality of life for developmentally disabled Californians is on the line.

If you listen to officials with the U.S. Health Care Financing Administration, there are "severe deficiencies" in medical care, and federal funding is at risk.

If you listen to state officials, most of the problems have already been corrected through a barrage of legislation last summer, and funding is not in jeopardy.

For the families and individuals dealing with mental health and developmentally disabled challenges, it looks like a classic finger-pointing exercise. To those on the front line, the right hand and the left hand may be talking, but their angry words are scary.

And, in the ultimate irony, the federal threat points out that medical care for the state's 35,000 developmentally disabled residents is "severely deficient" while -- in almost the same breath -- warning about an end to funding.

Do the Washington bureaucrats think that cutting off half of California's $500 million to provide services will actually improve the situation?

system.The goal has been noble and has resulted in many success stories as individuals move into small group homes or even their own apartments. But it has not been accompanied with adequate funding allocations to keep track of a dispersed clientele.
San Francisco Chronicle
Editorial
December 8, 1997

Challenge on disabled

California's new director of the Department of Developmental Services should consider a federal report on ``severe deficiencies'' in developmentally disabled care as an opportunity to prove he is putting the agency back on track.

The report by the Health Care Financing Administration lists a series of problems in the department -- from inadequate care homes to over-medication. If they are not addressed, the state could lose $250 million a year in federal funds.

The department has been beset with serious troubles, such as moving patients to poorly staffed and supervised group homes, as cataloged over the past year by Chronicle staff writer Edward Lempinen.

New department director Clifford Allenby is a longtime Sacramento hand known as a problem-solver. If he swiftly takes concrete action to right the wrongs outlined in the federal report, he will demonstrate that someone is finally at the helm of the beleaguered department who is serious about making improvements.

For too long, defensiveness has characterized department response to problems. Allenby can show that the tide has changed.
Los Angeles Times
Editorial
December 7, 1997

An uncivilized neglect of the mentally disabled

Civilization can be judged by how they treat their most helpless members, and California is failing. The state's care of the severely developmentally disabled, including the profoundly retarded, has declined so precipitously that the federal government has threatened to pull $250 million in federal funding.

It wasn't always that way. Since the 1950s, California state hospitals had pioneered humane ways of caring for mentally retarded and developmentally disabled citizens. Researchers at Camarillo State Hospital, for instance, have shown that many children suffering from severe autism, dismissed as mentally unreachable, can interact socially and live fulfilling lives of they are cared for by skilled professionals.

Now, with the hospitals mostly emptied and patients sent to cheaper nursing homes and group homes, inspectors found "unsanitary conditions," "inadequate nutrition" and instances where caretakers had completely lost tack of the patients supposedly in their care.

The old hospitals were not perfect. Many were large, expensive and far from their patients' home communities. In the early '90s the state dramatically stepped up a program to transfer the disabled to a variety of community locations. The state assigned the job of overseeing the homes to 21 "regional centers" that hire the community homes as subcontractors.

But the state made a fatal mistake. It transferred the patients but failed to transfer the kind of skilled health workers who could adequately supervise their care. With those jobs

The problem centers on the state's move in recent years to improve the quality of life for the developmentally disabled. Part of that effort has meant taking as many clients as possible out of institutions -- such as the Stockton Developmental Center, which closed in 1996 -- and putting them into a community-based care

For hundreds of years, the mentally disabled have been cared for in large institutions, grouped or herded into clusters where they could be watched closely. California's efforts to create more-dignified and independent living arrangements remain a good, humane idea. But -- as the federal report points out -- the move has a downside:

Caseloads are up, and many clients are no longer monitored or cared for as they should be. Access to medical care is harder to secure. Caregiver training needs to be improved, in some instances dramatically.

So, as this transition in California continues, along comes a federal agency with severe and threatening language in its review. And that's followed by a state response that improvement and changes already are under way, with a 30-day deadline to prove it.

For the sufferers and their families, all that matters is that their needs are met.

By not working as a state-federal partnership and jointly pointing the way toward solutions, the government agencies involved look like they've only added to the suffering and anxiety of those they're trying to serve.
handed over to unskilled, often minimum-wage workers, severely retarded adults were sometimes deprived of assistance with even eating and clothing themselves.

In the last year, several studies have documented the consequences of the state's transferring its most vulnerable population into loosely overseen facilities. When the studies first came out, Gov. Pete Wilson should have immediately halted regional center placements, something that the California Medical Association, Sen. Dianne Feinstein and many patient advocates urged. But the transfers were allowed to continue until now.

Two fundamental reforms are particularly urgent:

-- Raise staff credentialing standards. Washington has ordered Sacramento to transfer regional center responsibility from the state's Department of Developmental Services to its Department of Health Services, which makes sense because medical expertise has been so lacking and the focus has been so sharply on cost reduction. But transferring oversight isn't enough. The fundamental solution is in requiring higher levels of medical expertise and therapy in both the regional centers and group homes.

-- Beef up oversight. Studies in the last year have shown that many community homes fail to provide apropriate care -- dentists, for example, who are experienced in aiding patients who can't make even simple rewquests. Better monitoring would also ensure that homes at least keep track of their patients, and feed and clothe them adequately. The state needs to provide the Department of Health Services adequate funding and the power to punish violators. It should also contract with the University of California to provide regular progress reports.

Gov. Wilson has been quick to use the state's current budget surplus for tax breaks and useful, politically popular causes like class-size reduction. But this less visible need to protect and nurture the most helpless is urgent. The very measure of California hangs in the balance.

GOOD	BAD	WORST
Stockton Record Editorial December 10, 1997 Don't fail to meet the needs of the disabled In a war of words between Washington and Sacramento, the quality of life for developmentally disabled Californians is on the line. If you listen to officials with the U.S. Health Care Financing Administration, there are "severe deficiencies" in medical care, and federal funding is at risk. If you listen to state officials, most of the problems have already been corrected through a barrage of legislation last summer, and funding is not in jeopardy. For the families and individuals dealing with mental health and developmentally disabled challenges, it looks like a classic finger-pointing exercise. To those on the front line, the right hand and the left hand may be talking, but their angry words are scary. And, in the ultimate irony, the federal threat points out that medical care for the state's 35,000 developmentally disabled residents is "severely deficient" while -- in almost the same breath -- warning about an end to funding. Do the Washington bureaucrats think that cutting off half of California's $500 million to provide services will actually improve the situation? system.The goal has been noble and has resulted in many success stories as individuals move into small group homes or even their own apartments. But it has not been accompanied with adequate funding allocations to keep track of a dispersed clientele.	San Francisco Chronicle Editorial December 8, 1997 Challenge on disabled California's new director of the Department of Developmental Services should consider a federal report on ``severe deficiencies'' in developmentally disabled care as an opportunity to prove he is putting the agency back on track. The report by the Health Care Financing Administration lists a series of problems in the department -- from inadequate care homes to over-medication. If they are not addressed, the state could lose $250 million a year in federal funds. The department has been beset with serious troubles, such as moving patients to poorly staffed and supervised group homes, as cataloged over the past year by Chronicle staff writer Edward Lempinen. New department director Clifford Allenby is a longtime Sacramento hand known as a problem-solver. If he swiftly takes concrete action to right the wrongs outlined in the federal report, he will demonstrate that someone is finally at the helm of the beleaguered department who is serious about making improvements. For too long, defensiveness has characterized department response to problems. Allenby can show that the tide has changed.	Los Angeles Times Editorial December 7, 1997 An uncivilized neglect of the mentally disabled Civilization can be judged by how they treat their most helpless members, and California is failing. The state's care of the severely developmentally disabled, including the profoundly retarded, has declined so precipitously that the federal government has threatened to pull $250 million in federal funding. It wasn't always that way. Since the 1950s, California state hospitals had pioneered humane ways of caring for mentally retarded and developmentally disabled citizens. Researchers at Camarillo State Hospital, for instance, have shown that many children suffering from severe autism, dismissed as mentally unreachable, can interact socially and live fulfilling lives of they are cared for by skilled professionals. Now, with the hospitals mostly emptied and patients sent to cheaper nursing homes and group homes, inspectors found "unsanitary conditions," "inadequate nutrition" and instances where caretakers had completely lost tack of the patients supposedly in their care. The old hospitals were not perfect. Many were large, expensive and far from their patients' home communities. In the early '90s the state dramatically stepped up a program to transfer the disabled to a variety of community locations. The state assigned the job of overseeing the homes to 21 "regional centers" that hire the community homes as subcontractors. But the state made a fatal mistake. It transferred the patients but failed to transfer the kind of skilled health workers who could adequately supervise their care. With those jobs
The problem centers on the state's move in recent years to improve the quality of life for the developmentally disabled. Part of that effort has meant taking as many clients as possible out of institutions -- such as the Stockton Developmental Center, which closed in 1996 -- and putting them into a community-based care For hundreds of years, the mentally disabled have been cared for in large institutions, grouped or herded into clusters where they could be watched closely. California's efforts to create more-dignified and independent living arrangements remain a good, humane idea. But -- as the federal report points out -- the move has a downside: Caseloads are up, and many clients are no longer monitored or cared for as they should be. Access to medical care is harder to secure. Caregiver training needs to be improved, in some instances dramatically. So, as this transition in California continues, along comes a federal agency with severe and threatening language in its review. And that's followed by a state response that improvement and changes already are under way, with a 30-day deadline to prove it. For the sufferers and their families, all that matters is that their needs are met. By not working as a state-federal partnership and jointly pointing the way toward solutions, the government agencies involved look like they've only added to the suffering and anxiety of those they're trying to serve.		handed over to unskilled, often minimum-wage workers, severely retarded adults were sometimes deprived of assistance with even eating and clothing themselves. In the last year, several studies have documented the consequences of the state's transferring its most vulnerable population into loosely overseen facilities. When the studies first came out, Gov. Pete Wilson should have immediately halted regional center placements, something that the California Medical Association, Sen. Dianne Feinstein and many patient advocates urged. But the transfers were allowed to continue until now. Two fundamental reforms are particularly urgent: -- *Raise staff credentialing standards. Washington has ordered Sacramento to transfer regional center responsibility from the state's Department of Developmental Services to its Department of Health Services, which makes sense because medical expertise has been so lacking and the focus has been so sharply on cost reduction. But transferring oversight isn't enough. The fundamental solution is in requiring higher levels of medical expertise and therapy in both the regional centers and group homes. -- Beef up oversight*. Studies in the last year have shown that many community homes fail to provide apropriate care -- dentists, for example, who are experienced in aiding patients who can't make even simple rewquests. Better monitoring would also ensure that homes at least keep track of their patients, and feed and clothe them adequately. The state needs to provide the Department of Health Services adequate funding and the power to punish violators. It should also contract with the University of California to provide regular progress reports.
		Gov. Wilson has been quick to use the state's current budget surplus for tax breaks and useful, politically popular causes like class-size reduction. But this less visible need to protect and nurture the most helpless is urgent. The very measure of California hangs in the balance.