Saturday, October 31, 2009

DC took two years to act on quality of care issues at group home

From The Washington Post:

The group home provider was under the gun. The District was unhappy with the quality of care at Individual Development Inc.'s home on Edson Place NE. Effective immediately, the city said in 2007, it was taking steps to relocate its developmentally disabled residents.

Except it didn't.

A letter released this week makes clear that the city waited almost two years to take decisive action against IDI, a nonprofit group run by three prominent D.C. lawyers, and then did so only after questions were raised about the deaths of three IDI residents.

In the months before the city moved, the fragile, disabled people living in IDI's homes on Edson Place and 53rd Street SE endured a litany of indignities and mistakes, which are catalogued in a confidential report prepared by a federal court monitor and provided to the District.

At the 53rd Street home, a resident was slapped by an employee this year and was hospitalized last year with a head wound after the staff failed to secure the disabled person's seat belt in the shower, according to the report. Over three months last year, the same resident did not leave the home for a single documented community outing, the report said.

At Edson Place, one resident went without a recommended Pap smear or necessary dental treatment last year, according to the report. A wheelchair for the same person, promised for months, still hadn't arrived earlier this year, leaving the resident to use a wheelchair with inadequate support.

Details of the problems fill 16 pages of the report, which was released this week by the District under the Freedom of Information Act with names of residents redacted. Eleven more pages of the report detail the care of seven IDI residents who have died since 2004, including the three from Edson Place and 53rd Street.

The federal monitor's report spurred the city to act this month and laid the groundwork for a settlement finalized this week that requires IDI to improve its performance or face tough penalties.

Critics of IDI have been waiting for the District to act since October 2007, when it vowed to start pulling people out of Edson Place. Advocates asked repeatedly why the city wasn't keeping its promise, said Sandy Bernstein of University Legal Services, which represents many IDI residents.

"We never got a clear answer," she said.

The problem, said D.C. Attorney General Peter Nickles, was that officials needed the consent of the residents, their families or their attorneys to move them, and none would provide it. But the city did not take more aggressive steps, such as revoking IDI's license or going to court, as it did this time around.

On Oct. 5, the attorney general's office asked a D.C. Superior Court judge to appoint a receiver to run the Edson Place and 53rd Street group homes. A day later, the District's disability services agency suspended referrals to IDI's 11 group homes, which care for about 70 profoundly disabled people.

The dramatic action led to weeks of negotiations between the District and IDI, and to the settlement announced Wednesday night. Under the terms of the agreement, IDI must make significant improvement to all its homes over the next year or face the loss of its licenses. An outside monitor, selected by the city and IDI and paid by IDI, will oversee the nonprofit agency's compliance and will have the power to impose fines and other sanctions.

IDI's homes are funded solely through Medicaid. Many residents require round-the-clock medical attention.

The episode has been a striking reminder of the problems that plague the city's care of residents with profound developmental disabilities. For decades, many were housed at Forest Haven, a city-run institution in Laurel. But abysmal conditions there led to a class-action lawsuit in 1976 and to a court-ordered closure of the facility in 1991. Many residents were moved to group homes of four to eight people, typically operated by private entities under contract with the city.

Led by lawyer and lobbyist David W. Wilmot, ID emerged in 1996 to take over several group homes whose operator was foundering. Wilmot serves as IDI's president and is chairman of a three-member board that includes two other politically connected lawyers, A. Scott Bolden and Frederick D. Cooke Jr. Wilmot is paid $300,000, an unusually large salary at a nonprofit group such as IDI, and he has borrowed $300,000 from the organization.

Wilmot, who did not respond to a phone call seeking comment for this article, has, in a previous interview, defended his salary, IDI's performance and the loan he received from the organization. The attorney for IDI, Nicholas G. Karambelas, did not respond to a phone call seeking comment.

For years, Bernstein said, IDI has avoided meaningful sanctions by making promises that it doesn't keep. With IDI's leadership running the homes, Bernstein said she's not convinced that she will see lasting change, even with this week's agreement.

"How many chances does this provider get?" she asked.

Nickles said that past efforts to improve IDI had fallen short but that Wednesday's settlement was a step forward. "I thought more dramatic and pointed action was needed," he said, "and, very happily, the folks at IDI came to the table."