In Michigan there is a running joke that goes, “can’t find work, not interested in higher education, go into adult foster care.” Adult foster care is the regulatory designation for operation of small group homes which for decades have housed, cared for and often fulfilled the lives of those with mental illness, developmental delays, medical fragility and catastrophic injury. Most house 1-20 residents in residential structures.
For many years some of these homes have developed a reputation for being no more than a mechanism for warehousing humans whose families and society have no usage for. Story after story arises about residents complaining they do not have meaningful activity, their medical conditions are not being managed or they have been cut-off from caring family and friends by financially insecure providers who fear losing a resident who might see a better opportunity for a good life elsewhere.
It is also reported that from a regulatory perspective, in far too many instances the homes are not policed by nurses, even though the populations within them are increasingly medically fragile. One resident in Southfield, Michigan lamented, “I told this man (referring to a licensing consultant employed by the state) that I was catatonic dealing with these medication switches that my doctor arranged and they looked at me as though I was speaking Swedish. Staff did not see the need to ask my doctor to hospitalize me and the social worker from the state seemed to just write me off.”
In a system where an administrator of such a program qualifies with one, (1) year of experience working with the identified population and a high school diploma, its no wonder clinical professionals do not flock to open large numbers of really meaningful homes as they fear joining a club of people they look down upon. While it is true that some outstanding residential programs adhere to a self-policed elevated set of protocols and are managed by true professionals, i.e. Lovejoy Rehab, Creative Images and others, most cannot be categorized as such.
In one instance a provider picked up a resident from another provider’s home, took him to a Social Security Office and sought to arrange to become the payee of his social security benefits. Thankfully a court appointed guardian was on record and the action did not reach completion. This does underscore how financially desperate some providers are and why this “bottom-feeder” reputation plagues the adult foster care community when you have people willing to do just about anything to control an additional $700.00 to $800.00 per month.
Factors contributing to systemic and programmatic failure surely include unbelievably low public reimbursements for many residential services, including those for the mentally ill and the developmentally disabled. Add to that the city/suburban divide with providers in other counties refusing to align themselves with providers in Wayne County or the City of Detroit even for advocacy purposes. Why? Its most often tied to the perception that corruption governs every dollar for care spent in the inner-city and provider inadequacy has created substandard programs. These sentiments tend to always encompass Highland Park, Hamtramck, Ecorse, River Rouge, Inkster and Romulus that just get lopped into the formula in the minds of many.
To be fair it is by no means appropriate to judge the success of s system or the reliable and accountable care efforts of many well-meaning people based upon rumor, innuendo or city-bashing opinions of negative people. At the same time it is wrong to ignore people-driven issues that if not addressed through regulatory policy changes, will only make the already severely damaged network of providers worse.
We need specialty homes that are highly clinical with a clinically competent focus on specific diagnosis that keeps people out of nursing homes, served in their communities and with access to people who are well-qualified to monitor and address their needs. We need a requirement that administrators be certified by a professional rating system, perhaps the Assisted Living Director Certification available through the Assisted Living Federation of America. We need that boutique style of care that requires a modern set of regulatory guidelines and licensing designations with specific care requirements and protocols based upon the populations being served.
We need registered nurse case managers involved in licensing inspections of small group homes and plan of care development and higher standards of education and experience for administrators and licensees.
In the absence of meaningful change the process will surely erode in quality even more. Or do we just have to wait for the old guard – many of whom do not have a quality of life focus – to die?
A few presentations aimed at quality improvement:
Kitchen Management in the Group Home
Direct Care Workers Keys to Success
The Key Ingredient that Ruins Group Homes
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