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It’s about the care model

A disturbing incident involving an attempted rape of a woman by an intellectually disabled resident of a community-based group home last month can teach us all a valuable lesson.

We’ve been in the midst of the wrong debate here about care for people with intellectual disabilities.  We really shouldn’t be having a debate between “community-based” care versus institutional care.  What’s really at issue here is the care model for these people in Massachusetts.

Bear with me for a moment. 

On June 3, The Lowell Sun reported that a resident of a state-run group home in Chelmsford walked out of his residence, went next door and attacked a pregnant woman as she was sitting in her living room with her husband and three-year-old daughter.  The man managed to tear off Amy Hillman’s shirt and jump on top of her before he  was pulled away by Hillman’s husband, James.

The group home resident, Tholda Chhom, and James Hillman ended up in the front yard, where Chhom continued to charge at Hillman before running back to his residence just before police arrived, according to witnesses.  Chhom was later charged with assault and attempted rape, and has been placed in a “more secure state facility,”  according to The Sun.

Meanwhile, the Hillmans and their neighbors have been left asking questions.  Will Chhom be allowed to return to the group home?  Why were the Hillmans previously told that Chhom did not have violent tendencies, even though he frequently used to yell out of his window at passersby?

The Hillmans, in fact, were so concerned about Chhom, prior to the May 8 incident, that they built a stockade fence around their yard.  According to James Hillman, Chhom appeared to be left all day long in his room.  But on the day of the attack on Amy Hillman, the staff at the group home reportedly didn’t even know he had left the group residence.

It would be tempting for us to say that Chhom should never have been in a community-based group home; he should have been in a develpmental center, where, at the very least, it would have been more difficult for him to have gotten out out and to attack a resident in the community.  But that argument may miss the real point here.

What people like Chhom are missing in the community system — even in state-run community residences — is an intensive care model that meets the federal standards set for Intermediate Care Facilities.  ICF-level care, which happens to exist only in the developmental centers in Massachusetts, stipulates that residents receive onsite clinical, medical, and nursing care and full-time supervision.  Not everyone with intellectual disabilities needs this level of care.  Only a small fraction of them do.  But Chhom would appear to be one of them.

That’s why we’re so upset that the Patrick administration is shutting down four of the six remaining developmental centers without replacing the ICF care model available in them.  We don’t want the big old buildings there either.  It’s the ICF care model we want to preserve for those who need it.

We think the current residents of the developmental centers should be able to stay in their current locations in the most cost-effective residential settings, while receiving the same level of care from their familiar staff.  That might well mean they would live in small group homes on the campuses — the “postage-stamp” idea.  Meanwhile, other people in the community, such as Tholda Chhom, who need that level of care, should be able to receive it as well.

But the administration is seeking to eliminate the ICF model and replace it with care under which the ICF standards have been waived.  It’s referred to as community-based care, but it should really be labeled “waiver based” care, because the standards are lower.  Direct-care staffing levels do not have to be as high, clinical and medical personnel can “float” among different homes in geographic regions, and medications can be administered by people with less training.

What does this mean for the safety of neighborhoods around the state where thousands of community-based group homes exist?  What does it mean for people like Tholda Chhom, if there will no longer be an ICF-level facility one day to accept him?  Will he simply be thrown into prison?

Once again, let me be clear.  I’m not trying to make an argument here to preserve the six developmental centers as they exist today, although no doubt we’ll continue to be accused of that. 

Go ahead, call it all community-based care.  Just keep the care model and let the current residents of the developmental centers stay in their current locations with their familiar staff.   And finally, provide the opportunity for ICF-level care for all who need it, such as Tholda Chhom.

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