Md. must support community care for the disabled

March 31, 2010|By Thomas M. "Mac" Middleton

As chairman of the Senate Finance Committee, I have been privileged to advocate for Marylanders with developmental disabilities and mental illness and for the agencies and staff who have dedicated their lives to providing them services. During the last few decades, Maryland has rightly moved from expensive, segregated, state-run institutions to a system that serves the vast majority of people with developmental disabilities and mental illness in communities and neighborhoods.

Community-based providers take pride in offering quality supports that help people achieve maximum independence. These organizations rely on state and federal funding to provide a community-based alternative to state institutions.

Unfortunately, over the course of many years, the state has chronically under-funded community services, resulting in a low-wage work force and eroding funding for life in the community. Budget cuts have also led to cutting supervisory and quality oversight staff. These decisions come after most agencies cannot find anything left to cut from their budgets, and additional charitable fundraising is exhausted.

Direct support staff, the backbone of care and support, earn low wages and face challenges that would daunt many of us. While the state pays a starting wage of $12.50 to $15.80 per hour for direct support staff in state institutions, it reimburses community providers $9 or $10 per hour for staff who do the same work in community settings.

Red flags have appeared during the last few years. An independent commission appointed by the governor reported that in 2007, 1 in 3 developmental disability providers ran a deficit. In 2008, a state task force identified many of the financial problems facing developmental disability services. Staff turnover rates in mental health programs exceed 30 percent, and vacant positions remain open for months, despite the high unemployment rate.

In 2009, a large residential services program closed because of under-funding, transferring care and support to other providers and creating upheaval and expense as a result. This year, another provider is reportedly closing because of under-funding.

While the cost of care in state residential centers and psychiatric institutions is more than $200,000 per person per year, community providers support people with developmental disabilities who have the same needs for an average of $70,000 to $85,000 per year.

For people with mental illness, the cost of the most intensive community-based care is generally less than $50,000 per year, half of which is paid for by the federal government.

The demand for developmental disability and mental health services is overwhelmingly community-based. People want to live in a neighborhood and work in the community, rather than in a state-run institutional setting.

So why hasn't more been done to protect Marylanders with mental illness and developmental disabilities?

Many of us in the General Assembly have championed this issue over the years, but the time has come to address the chronic under-funding of services for more than 120,000 adults and children in Maryland. This year, Gov. Martin O'Malley and my colleagues in the General Assembly have an opportunity to do just that.

Senate Bill 633 and House Bill 1034 would require that the state provide the same inflationary adjustments for community services that it provides for its own budget. In years when the state could not afford to budget for inflation, community providers would share the pain. But in years when the state could afford inflationary increases, community providers would receive the same consideration.

I am proud to be the sponsor of this legislation in the Senate and to work with Del. Bob Costa as the House sponsor and Sen. Ed Kasemeyer, vice-chairman of the Budget and Taxation Committee, who have been passionate advocates for this legislation. The bill has passed unanimously out of the Maryland Senate. As we enter the last few weeks of the legislative session, we have an opportunity to address this issue. Marylanders with developmental disabilities and mental illness, their families and the agencies that provide support for them cannot wait any longer.

Thomas McLain "Mac" Middleton is chairman of the Senate Finance Committee of the Maryland General Assembly. His e-mail is

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