Human services provides an opportunity for structural change

For years a debate has taken place as to how the state can best and most economically assist the developmentally disabled — people dealing with mental illness, those struggling to overcome the disease of addiction, the vulnerable elderly and others in need of human services.

Connecticut has long used a hybrid human services system that is neither logical nor efficient.

State agencies and employees of the state help some citizens in need of services. Others receive their services from a network of hundreds of private, nonprofit providers working under state contracts.

As Connecticut has confronted an ongoing fiscal crisis both state human services agencies and the nonprofit community have experienced cutbacks, but the pressure placed on the nonprofits has been acute as the legislature sought savings there that it could not achieve in the public sector due to contractual labor obligations.

The General Assembly and incoming governor Ned Lamont have an opportunity over the next few years to decide whether to continue with the hybrid system, with its arbitrary breakdown of who gets served by state-sponsored agencies and who ends up in the nonprofit sector, or move definitively in one direction.

The opportunity arises because many state human services workers will be reaching retirement age. The administration, working with the legislature, can either choose to replace them and perpetuate the programs or use the occasion to move to a system in which most services are provided by the private, nonprofit sector.

That latter choice would be the better move.

There is no argument that the private nonprofits provide services at a lower cost. Moving this important work to the private sector would free the state of long-term pension and benefit obligations.

Union leaders note, quite correctly, that the reason these nonprofits are able to provide human services more cheaply is that their employees are not paid well. Some qualify for food stamps and other social programs.

If the state were to move to a mainly private nonprofit based system of care it would have to address the low-pay situation through contracts that allow for reasonable compensation. Otherwise, these programs would have difficulty attracting the workers they need, particularly as their mission grows.

However, as state workers retire the state should see enough savings to move services to the nonprofits, improve the compensation situation, and still find overall savings.

As for quality of care, the most recent in-depth look found it was comparable among state and private providers.

The 2012 Program Review and Investigations Committee study looked at the issue as it pertained to caring for people with developmental disabilities. At that time it found the Department of Developmental Services provided 24-hour residential services at the Southbury Training School and several regional centers. DDS also operated and staffed 70 group homes. The state was contracting with the private sector to operate another 800 group homes and about 70 intermediate care facilities for intellectually disabled clients.

I could not locate an updated study.

The 2012 study recommended accelerating a phase out of state-operated services, except for a small segment of the client population, and moving to the private nonprofit model.

“Supporting the private provider model for provision of residential services are the findings … on quality of care. Based on the lower number of deficiency citations in both private group homes and intermediate care facilities compared to the public settings, the committee finds that the quality is not lower in the private sector,” concluded the 2012 review.

The worst decision would be no decision, letting inaction continue the status quo. If Lamont truly wants structural change, here is a place to start.

Paul Choiniere is the editorial page editor.

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