But logistically, it’s a different story.
Placing ICF residents into community living situations has lately become a nearly impossible task, according to Coccia, who has been trying to help identify appropriate caregivers. Many providers are demurring because the DPW’s recently restructured payment rates are no longer sufficient, she says: “This is a new problem for us.”
DPW spokeswoman Donna Kirker Morgan denies that DPW has had trouble finding caregivers. She says the delay is due to an “enhanced … person-centered planning process,” designed “to make sure that what the individual needs to be fully included and successful in the community is clearly identified.”
But Kathleen Brown McHale, president and chief executive of Special People in the Northeast (SPIN), says the rates have been a significant barrier in the case of her nonprofit. “We have been asked to take people, and some of them we’ve said ‘no’ to. I don’t think we’ve gotten a referral that we’ve been able to take at all recently from an [ICF],” she says.
Brown McHale says those left in ICFs are the highest-need cases, since many have co-occurring psychiatric conditions or physical disabilities. But the state has reduced its rates the most for these super-high-need “outliers,” making them even harder to serve.
“The people in the Benjamin settlement aren’t getting services because they have a high need for support,” she says, “and that’s just the beginning of people not getting services.”
SPIN, she says, is already reeling from other cuts and growing expenses. It’s losing an unsustainable half-million dollars a year on housing costs alone, even after aggressive refinancing of its mortgages. It doesn’t help, she says, that while residents in similar homes elsewhere in Pennsylvania can obtain food stamps, all but a handful of the residents in SPIN’s Philly houses have been denied. “We have cut every cost we can in every one of our homes. We were asked to provide these services, we were asked to provide them in homes, and now the state doesn’t want to pay what they cost.”
In the meantime, the delay in moving people out of ICFs may come at the expense of the approximately 15,000 people now on Pennsylvania’s infamously long waiting list for intellectual-disability services of all types.
“For every person in a state center, we could serve 20 off of the waiting list,” Coccia notes.
More than that, she says, it shouldn’t take a lawsuit to get the state to make and carry out a plan (as required by the federal government) to give everyone a shot at living in the community.
“Even now, there seems to be no commitment to moving forward,” she says. “To me, this state is long overdue.”