Trouble in Community Care

In 1993, the state accelerated its transfers of developmentally and emotionally disabled patients out of public hospitals and into a variety of community locations, mainly patients’ own family homes and “community homes,” houses with six or fewer beds operated by entrepreneurs under contract with the state.

The transfers, compelled by a federal lawsuit, have enabled many patients to live more fulfilling lives, in their own communities. Taxpayers have benefited too; the average yearly cost is $125,000 for a patient in a public hospital but generally less than half that for a patient in a community home.

However, as recent and mounting charges being brought against the state attest, the transfers are sending some patients into homes that lack the expertise and funding to care for them. One of the state’s own recent studies bears out a lack of oversight, acknowledging serious problems that range from “probable overuse of psychotropic and sedative medications” to a “significantly lower rating of health care quality.”

Until the state improves its oversight, Gov. Pete Wilson ought to temporarily halt community placements, something that the California Medical Assn. and Sen. Dianne Feinstein and other patient advocates have been urging for months. But the majority of state hospital patients have already been transferred (a recent wave came from the Camarillo hospital). What’s vital now is assurance by the state Department of Developmental Services (DDS) that community placements retain at least the same quality of care as state hospitals. The regimen should include appropriate drug and social skills therapies.

This week, the state Senate is taking a step in that direction, considering two bills sponsored by Sen. Mike Thompson (D-St. Helena). SB 1038 would require the DDS to reassess how it allocates funds to the community homes, which is important because of recent cuts in Medi-Cal compensation rates. SB 1039 would require the DDS to help community homes secure the more specialized care required by certain patient groups. For example, the severely retarded may need a dentist experienced with patients who cannot understand the simplest request.

If lawmakers act wisely to tighten state oversight, patients ought to be able to receive the quality of care of the better state hospitals, at costs that Californians can afford.