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Disabled, taxpayers to benefit by shifting state focus

While it is well known that Louisiana continues to operate state-owned hospitals that Gov. Bobby Jindal wants to wean out of state responsibility for indigent care through health care reform, perhaps less realized is that the state has a similar arrangement with homes for the developmentally (meaning mentally and physically) disabled. Fundamental reform should come to this area as well, but parochial attitudes of legislators may prevent that from happening.

Unfortunately, for decades the state has had a bias in all areas of health care towards the warehousing of individuals into large institutions, benefitting certain special interests and creating patronage tools for legislators. As the times have changed where technology has allowed solutions to severe health problems that permit more home- and community-based living at a reduced cost, this inertia now needlessly costs taxpayers – Louisiana on a per capita basis has more than double the number of people in developmental centers than the national average and thereby has the fourth most people in such centers out of all the states.

Testimony in front of the House Appropriations Committee’s Subcommittee on Health and Welfare illuminated the fact that the typical resident of the six remaining centers – New Orleans’ basically had to surrender its residents in the wake of the hurricane disasters of 2005 – costs the state $127,000 a year, while the typical participant in the state’s New Opportunities Waiver program which allows individuals to live at home or in a group setting using workers paid for by the state averages only $70,000 annually. The savings actually should be much greater, given that NOW’s participants are at the highest levels of disabilities and almost 20 percent of those currently in the centers are at the lowest levels – those most likely to benefit from home- and community-based care – where estimated costs under NOW are considerably lower. (As the program expands, the estimated cost for new entrants, who would be needing lower levels of care, this year is forecast to be only $44,208 each.)

The experience of the winding down of the New Orleans center was that over half of the residents and their families chose to have residents move into the community. If four of the six centers with residents were phased down at this same rate (the remainder choosing to move into supports and services centers that would remain open in Bossier City and Iota), savings could be over $38 million a year, and this doesn’t include money the state could bank by selling the unused facilities. If then the yearly savings were applied to fund new waiver slots (over 9,000 who have qualified remain on a waiting list, often for over a decade with some dying before ever receiving a waiver), at the predicted cost about 850 could be served.

If some legislators were not moved by the economics of the matter, they should have been by the human costs. Many families who have members in the centers resent being forced, with no options available, to have their loved ones have to live in these places when with some assistance from the state they could care for them at home, or at least in a community setting. Not only does this convey a psychological benefit, another economic benefit is present as well: outside of institutions, some of these disabled will be able to hold down jobs and contribute to the economy.

Some families do prefer having the centers around because they are unable or unwilling to care for their disabled member, and some residents have no family. A growing number of states have no such facilities at all now, instead having created programs that allow for their care in private sector settings, but even if the state did keep operating a couple of facilities the option would be there for state care. Certainly this might mean longer trips for families to visit and it might be initially disruptive for some residents to move. But it is unfair to ask taxpayers to surrender tens of millions of dollars annually extra just for the minor convenience of a few hundred families.

Yet legislators will often use this rhetoric on the issue about how they want to help these residents and their families (keep in mind many would far prefer the waiver solution) to mask their real motivation to continue to support the inefficiency of this system: it permits state money to pour into their districts and creates jobs, both of which assist them in their abilities to get reelected, as well as presents a veneer to some families about how a service (which could just as easily be done in the private sector without any state involvement) is being performed for them, again worth some votes.

It’s the same dynamic as witnessed in the case of the state’s charity hospital system and falls squarely into the state populist tradition of having government provide what can be better provided from other sources in order to attain power and prestige. If legislators prove too inured to this old siren song, hopefully Jindal will not be and will push a plan to move the state out of the disabled housing business and into policy that is more cost effective and overall improves the quality of life for the disabled in Louisiana.

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