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Group Homes For Disabled Hit 'Tipping Point'

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By SHERRI ACKERMAN

The Tampa Tribune

Published: May 26, 2008

CLEARWATER - When the first wave of state budget cuts came, the Upper Pinellas Association for Retarded Citizens looked for savings wherever it could.

Administrators took on maintenance chores; it wasn't unusual to see the group's director mowing the lawn or fixing a toilet at one of the agency's group homes.

That was before the Legislature voted once again to cut rates paid to agencies serving disabled people, slicing $43.5 million from the state budget for the upcoming fiscal year.

At the same time, lawmakers created a new system to limit Medicaid spending, which for some disabled Floridians may mean a loss of services.

Now UPARC and agencies offering adult day care, job training and other help to disabled residents say they're facing even more painful choices: consolidating group homes into fewer but larger facilities, turning away new clients or even the previously unthinkable - discharging some residents.

"It's at the tipping point," said Dick Bradley, executive committee president of the Florida Association of Retarded Citizens. "Many providers are going to say, 'I can't serve these individuals anymore.'"

The Upper Pinellas Association for Retarded Citizens is among 42 such associations and hundreds more group home operators in Florida grappling with a nearly 6 percent rate cut approved by legislators.

The rate cuts will be implemented by the Agency for Persons with Disabilities, which faces a 3.8 percent decrease in its $1 billion budget compared with the previous fiscal year.

"The cuts are not for direct services for consumers," said agency spokeswoman Melanie Mowry Etters. "But certainly the provider will have to decide whether or not to offer services."

Lawmakers also created a tier system to limit Medicaid spending and keep the agency within its budget. Disabled citizens will be reassessed by state workers and assigned to one of four waiver levels, with Tier One featuring no limit on spending to Tier Four capping spending at $14,792 a year.

Providers are considering a variety of ways to deal with expected shortfalls.

UPARC serves 450 disabled residents with an annual operating budget of $12.5 million. Officials there expect to lose $1.3 million: about a third from the rate cuts, the rest from the newly created tier system.

Agency director Tom Buckley said he might have to discharge up to 15 residents - many he has known for more than two decades - from the agency's 21 group homes.

That would be a last resort but it might be the only way to maintain a safe environment for the majority of residents, Buckley said. He vowed his agency would not budge from its standard of no more than two residents per staff member or its current rates.

"Our staffing and rates are not going to change," he said. "We will not put the persons we serve in harm's way."

The Hillsborough Achievement and Resource Center in Tampa has a $5 million operating budget and serves 450 people with disabilities a year.

Discharging residents "would be a very difficult decision for me to make," said Richard Lilliston, HARC's chief executive officer. He said the agency is considering consolidating its eight group homes to deal with a $500,000 loss in funding.

"Our clients have gotten older," Lilliston said, adding that relatives have died or faded away. "There's no one to really discharge them to."

Agency Needs $250,000

The agencies provide services including adult day care, where disabled people participate in classes and job training. The associations also operate residential homes for some clients with on-site staff to assist with care and transportation.

The goal is to help each person live as independently and safely as possible.

UPARC officials met with families this week to warn them dire changes might be coming. Many were stunned, said associate executive director Sheldon Hershman. The agency will search for grants and other donations but needs about $250,000 to ensure residents stay put, he said.

John Kiker, a UPARC director whose 36-year-old autistic son, Karl, lives in one of the group homes, is planning for the worst.

No one knows yet what tier Karl Kiker will fall into, said John Kiker, 63. If his son has to move back home, Kiker's 62-year-old wife will quit her job to provide care.

"We don't have any other alternatives," Kiker said.

Residents who are discharged from their group homes will have to lean on the Agency for Persons with Disabilities to help them find new housing, Buckley said.

Tier System Delayed

Both the rate cuts and the tier system were set to go into effect July 1, but the tier system has been delayed because of an injunction filed May 8 by the Florida Advocacy Center For Persons With Disabilities.

In its petition, the Advocacy Center criticized the Agency For Persons With Disabilities, arguing the agency will use an invalid method to reassess some 30,000 people to determine which tier they will be placed in.

The Florida Association for Rehabilitative Facilities also has sued the state, questioning the need for the rate cut. Etters said the lawsuit has been put on hold while all parties work toward a resolution.

Suzanne Sewell, the agency's director of membership and program services, said agencies that serve the disabled are facing a double-whammy: funding cuts and trying to come up with new budgets when they don't know yet which residents will be assigned to which tiers.

"Our providers are having to look at their rates when they don't even know what they're going to be," Sewell said.

With the exact amount of funding cuts in flux, groups that work with disabled people are scrambling for options.

Bradley, leader of the state Association of Retarded Citizens' executive committee, also heads up the Alachua County Association of Retarded Citizens in Gainesville.

He doesn't expect his agency to remove anyone from its 13 group homes but hasn't ruled out the possibility. The rate cut will result in a $350,000 loss from his $10 million annual operating budget and the tier system could cut even more.

After previous cuts that began in 2003, the association laid off about 20 employees, Bradley said. This year, with 300 employees serving about 300 clients, "We just don't have anything else to give," he said.

"Where do you go? You say you're not going to serve certain individuals."

Reporter Sherri Ackerman can be reached at (813) 259-7144 or sackerman@tampatrib.com.

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