The following summarizes some of the serious issues/concerns shared with MOMS regarding CLBC’s management and oversight, particularly regarding efforts to reduce the costs of supports and residential care contracts. These issues are being brought forward by concerned CLBC insiders and service providers as well as families and they illustrate the need for a full independent review of the government’s and CLBC’s management of the $700 million community living sector.
Many service providers are being forced to accept reductions as high as 50% to 80% to the value of their contracts, while continuing to deliver the same or higher service levels as their clients age. There are vast discrepancies between the amounts paid to different providers. While these may be justified in some cases, given the range of different needs, it remains very unclear why some providers are targeted for cuts while others are not, and/or to what extent such cuts are reasonable.
Since 2010, when CLBC quietly launched its “service redesign” initiative, the agency has been relying on a controversial new assessment tool called the Guide to Support Allocation (GSA) to try to create a standard measure of need. The GSA remains in draft form – it has never been officially approved as a policy tool and when MOMS first asked about it last year, CLBC insisted it was an internal document that could not be shared publicly!
The GSA has since been widely criticized as flawed and inadequate in assessing real needs. The application of this tool has also been widely criticized. Clients’ needs levels have been dramatically downgraded without any consultation in many cases. Adults, families or care providers who disagree with the results of the assessment have no transparent checks and balances or independent appeal mechanisms to verify that the reductions are reasonable. Budget reductions based on the GSA have been unilaterally enforced by CLBC on contracts for family respite, group homes, day programs and other services. However, contractors tell us that they are warned that if they complain or object, their contracts could be cancelled entirely and given to another contractor who is willing to deliver lower standards of care.
Threats, intimidation: a climate of fear
The mandate to significantly cut costs, coupled with the lack of a fair process for determining funding levels, has led to widespread complaints of both overt and implied threats, intimidation and a general climate of fear within community living. Families, staff and service providers have repeatedly told MOMS that they cannot complain publicly because they have either been told or believe that there will be reprisals, such as further cuts or cancellation of their existing services or contracts, if they go public with complain about CLBC. Agencies and staff are coming to MOMS with complaints because they have nowhere else to go. As a volunteer family support network, we are not equipped to handle such concerns and have been pleading with the minister responsible for over a year now to establish effective mechanisms to address these issues.
Agency objectives, incentives put dollars before people
Bonuses for senior CLBC executives and mid-level managers have been tied to CLBC service plan objectives that promote moving as many adults as possible from group homes into less costly models of care such as home shares. This provided a financial incentive to overlook the appropriateness of a recommended care model and/or the quality of care, as long as the placement produces savings for CLBC. This incentive bonus structure existed at all levels of the organization, not just among senior executives. On Friday, the Minister announced an end to this incentive pay system, although it appears that managers will still receive the same money as part of their regular pay. Moreover, CLBC’s service plan objectives have not changed, so these will continue to guide the kinds of decisions that put savings ahead of the interests of individual clients.
Conflicts of interest
Several sources have told MOMS that some CLBC staff, including senior managers responsible for budget cuts to other programs, are allegedly moonlighting to provide home share themselves. The home share contracts are allegedly subcontracted through agencies and microboards, so they don’t show up in CLBC’s published contract list. If these reports are accurate, it presents a serious conflict of interest, as senior staff would have a financial incentive to protect and promote a model of service from which they are able to derive significant additional financial benefit. If these arrangements are subcontracted as reported, the contracting agency would find it hard to take action against a negligent home share subcontractor who also happens to be a CLBC employee or manager with the power to make budgetary decisions that affect the agency’s or microboard’s viability. In the child welfare system, social workers are not allowed to accept foster contracts because of similar conflicts. CLBC apparently has no such policy with regard to its own staff. This is another symptom of a very disturbing and endemic culture and of the systemic nature of CLBC’s challenges.
Most of the adults served by CLBC have limited verbal skills and no family/friends in their lives to speak up on their behalf if something bad happens to them, and so they are particularly vulnerable to all forms of abuse. Checks and balances to address these risks should include licensing, inspections and public reporting by an independent oversight authority, promotion of care models and or individual care plans in which multiple staff or providers can keep a check on each other. CLBC has none of these safeguards in place. The oversight gaps are most serious with the informal models of care like home share, which CLBC has been promoting to save money (Group homes are subject to licensing requirements but not home shares). There is no independent investigation of systemic complaints (the advocate for service quality has an extremely limited mandate and reports to the minister). There is no independent monitoring of caregivers and no public reporting.
Family role discouraged
One agency told MOMS they encourage families to establish Representation Agreements (which give them a legal voice in life decisions on behalf of their adult relative) as a safety check, especially to address the potential for financial abuse and to provide external support and advocacy. But CLBC has actively discouraged this practice among clients, who are penalized under CLBC’s needs assessment tool if their families have a Representation Agreement in place. CLBC was created with the goal of giving families and adults more control at all levels, from policy development to individual care decisions. But former Minister Rich Coleman ended the strong role of families and self advocates on CLBC’s board. There was no consultation with families or the public in developing the service redesign process launched in 2010. And families have increasingly been excluded from individual care and support decisions.
Need for independent advocacy
Families sharing their concerns in the past year through MOMS have stressed the urgent need to establish an independent advocate with a broad mandate to ensure that CLBC is able to offer an appropriate choice of support options, with checks and balances to ensure the delivery of support in ways that respect the rights, safety and wellbeing of adults with developmental disabilities and their families. On Friday, the Minister cited the existing Advocate for Service Quality, and suggested that independent advocacy and oversight already exists. The existing office is not independent (it reports to the minister) and the limited mandate prevents the office from providing proactive advocacy, effective oversight and/or addressing systemic issues. The disturbing complaints surfacing via the media are evidence that the current model is ineffective and has allowed bad decisions, abuse and neglect.
On Friday, the Minister also announced the creation of a client response team, with a number to call for complaints. However, that number simply directs callers back to CLBC – the very organization responsible for the problems. Self-policing is not an effective remedy. A further concern is that many adults served by CLBC, especially those with limited or no verbal skills and/or no family in their lives – i.e. those most vulnerable to abuse – will be unable to initiate contact and access support from this client support team on their own, just as they are unable to access the support of the existing Advocate for Service Quality. This is another ill-conceived remedy that fails to understand or address the real systemic issues. This again highlights the need for an independent advocate, especially to look out for the many older adults who may not have families to support them.
CLBC compiles (or used to compile) regular internal reports to its board on reported deaths and critical incidents among residential clients. CLBC may also launch its own investigations when there are allegations of severe abuse. However none of this information is ever made public. It is not known to what extent abuse and neglect go undetected. And where problems are detected, CLBC, its staff and its contracted care providers are allowed to bury the damaging evidence and are not held publicly accountable.
CLBC has been pursuing a major shift from models like group homes run by contracted community agencies to home shares, which are increasingly provided by independent, unlicensed and unacredited subcontractors. This raises a number of concerns, since the agency’s management and accountability system is focussed on contractors. Subcontracted caregivers are not listed in the agency’s public list of contractors and may rarely if ever come into contact with CLBC managers. If something goes wrong with a subcontractor, there is incentive for the contracted “middleman” agency to keep it quiet to avoid jeopardising their own broader contract. CLBC is basically asking its contractors to police their subcontractors. The shift underway therefore raises serious questions issues that warrant consideration by independent experts to ensure that appropriate accountability mechanisms are in place.
Last week, the last block of Woodlands was torn down, symbolizing the end of an ugly chapter in our province’s history. But the fear is that we have not learned from the past and that indeed the reforms underway in community living may be recreating all the key factors – isolation, lack of transparency, independent oversight and public accountability – that allowed abuse and neglect to thrive in the old institutions.
We know there are many good, committed people throughout the system, who deserve credit and respect for the great work they do and for their unquestionable commitment to helping people with developmental disabilities live lives that respect their enormous potential as fellow human beings as well as their challenges. The Premier needs to stop trying to cover up the problems and take decisive action to restore confidence in community living and to ensure that the positive work being done can be fully recognized and supported.
Dawn & Cyndi, MOMS