I would be interested in hearing from people whose loved ones are cared for in residential venues in the general community how they find the oversight of them. Is it adequate? In the RHCs of Washington State, abuse is not impossible, but it is unlikely and, if perpetrated, it is likely to be caught and stopped quickly, due both to reporting requirements and reporting practices that protect the identity of reporters.
Who is there to catch and report such abuses in private, semi-isolated residences? Especially in situations where there are only one or two caregivers for several residents per shift? What safeguards are there to assure that such abuses don't get hidden for fear of making the facility look bad? In Washington, abuses that are reported are investigated, but the quality control system for general community residences for people with dd that should be protective of residents, in fact, depends on reports. This means the abuse must already have occurred!
A recent law requiring background checks for caregivers is a step in the right direction, but "community" caregivers' wages can be very low, meaning that young people, barely out of high school, may be the only people able to take such work. When this is the case, the records of young offenders will have been wiped clean.
Issues of safety and quality assurance are major problems that would have to be solved before I would ever be able to consider moving Kathy, my sister, from an RHC.
What is your experience &/or perspective?
Saskia
In the past, cost of care, has been one of the stated driving forces to close RHCs. There have been no documented analyses that take into account the whole cost of care. This would include the cost that would be shifted to other budgets by closing RHCs but those costs will still be present. Some of these costs that are not seen are the cost to public aid (fire, police and aid calls), hospital ER admissions, ambulance rides to and from appointments and nurse visits for assessments, medications, treatments and blood draws. In addition to those costs, there would be added costs due to the necessity to purchase more equipment (lifts, special tubs, safety ramps, environmental adaptations for safety) there are the added burdens of less people doing more work (laundry, personal care, shopping and cooking) in a smaller household. I do not see where there would be any cost saving at all by closing the RHCs and transferring the care to smaller residences.
ReplyDeleteI’m not an economist but common sense tells me about cost saving issues when one is able to centralize services. By looking at economy of scale, one can clearly see that utilizing the facilities that we currently have in place and particularly if we were able to use them to capacity, there would be a large cost savings in this. So, I KNOW that cost savings is not a reason to close the RHCs.
I had thought that DSHS did think about the safety of the residents (and staff) though and now with decisions that are being made, I have realized that safety of our residents and the staff that care for them are not a priority either.
Moving these residents to smaller homes is a very unsafe move. Not taking into account the issues with transitions and how disruptive moves can be for anyone, placing these residents in homes without the necessary support only sets them up for injuries and death. Some advocates have even written about safety as if it is not a concern. (http://thearcofkingcounty.wordpress.com/2010/04/12/inclusion-a-history/#comments)
To me, as a health professional and parent, safety is paramount. Safety is one of the reasons that many of these residents do live in RHCs. Having knowledgeable and trained staff in presence with back up as needed is necessary to maintain the safety not only of the residents but also of the staff. Placing complex and/or medically fragile residents in an isolated home without adequate staff back-up is a sure disaster waiting to happen. What will be the cost of cleaning up these disasters? Certainly much, much more than what would be spent if we utilized the RHCs – and that’s just dollar cost – not the cost of lives lost and injuries incurred (both residents and staff.) So, now I know that SAFETY is not a concern either.
If both SAFETY and COST are not areas of concern with DSHS and some advocates by pursuing RHC closures, what are the motivations? In one article, Susan Dreyfus stated that parents are asking for these homes. ( http://www.kitsapsun.com/news/2010/dec/22/dshs- secretary-tells-families-that-the-end-of-is/#ixzz193WhdWPU) I don’t know of one parent, family member or guardian of an RHC resident who would put the safety of their loved one at such risk just to have them closer to home. Yes, it isn’t great to have to travel to visit your loved one but it also is not great to have to worry every minute about their safety. It is this reason that we need to maintain the 5 RHCS that we have in different parts of the state so that people who need these services can at least make a day trip to visit their family members.