February 23, 2007

Hon. Tom Christensen,
Minister for Children & Family Development
Victoria, BC

Dear Mr. Christensen,

Several documents in the public realm have recently raised concern about your government’s direction, through CLBC, to restructuring residential services for adults with developmental disabilities. These include: a leaked CLBC proposal referencing plans to close up to 100 group homes; Oct. 27/06 Memo from a CLBC Vice President to Quality Service Managers re “Monitoring Placement Activity in Shift Operated Staffed Residential Homes”; and CLBC’s 2007 Service Plan. These documents challenge commitments from your office and CLBC to building a sustainable system that offers choice and quality care so that individuals can find homes best suited to their needs, wants and dreams.
At our Oct. 4 meeting, the Residential Options Project (ROP) was a key topic. We were encouraged by your commitment then and in a subsequent letter to, “meaningful choice, person-centred services and the continued operation of licensed group homes.” CLBC similarly stated that the ROP allows people “to identify the residential support that works best for them – rather than placing them in a situation that is not ideal.” Choice and suitability have been repeatedly emphasized as the primary objective of this review, with potential savings as a welcome, but not a driving factor.
Given budget pressures facing CLBC, we stressed the need to conduct this review independently to ensure the savings objective would not trump commitments to meaningful choice in discussing options with individuals. We therefore welcomed the assurance in your Dec. 2006 letter that “this ROP is separate from the operational system, reporting directly to the CEO.”

The Oct. 27/06 memo from CLBC’s Vice President for Quality Services to all Quality Service Managers was subsequently brought to our attention. It outlines a very clear operational role in the conduct of the ROP, with close collaboration and reporting requirements between operational managers and ROP leaders. The memo even identifies a shared goal for operations and ROP staff, i.e. closure of group homes as a result of residents choosing alternatives. This contradicts your assurance that the ROP is independent of CLBC’s operations. It undermines confidence that options are being presented objectively, with individuals’ best interests foremost, and that choices are based on full understanding of risks and implications, especially for the many adults without independent advocates to help consider their best interests. This concern is supported by complaints to BC FamilyNet that ROP staff will only consider cheaper alternatives to existing homes.

The Oct. 27/06 memo also instructs managers that placement into a group home should only be “done as a last measure after all other options have been explored.” This instruction contradicts commitments to meaningful choice, to maintaining group homes as one of those choices, and to helping individuals access options that best suit their needs.
A further concern is the memo’s reference to leaving group home spaces empty, when thousands are waitlisted to access those spaces. This approach is consistent with the strategy articulated in CLBC’s first Service Plan to leave group home spaces unfilled to facilitate the home’s eventual closure. In the context of these other documents, it seriously questions the commitment to honour choices made so far in the ROP by the vast majority of residents who have chosen to stay in their group homes.

The recently leaked proposal from CLBC’s CEO incidentally referenced CLBC’s intent to close up to 100 of BC’s 680 group homes and to transform many of the rest into a new model with lower staffing requirements. That document was withdrawn, but the same intent is now noted in CLBC’s 2007 Service Plan. The plan acknowledges that demands cannot be met within current budgets, that waitlists will increase and that these pressures require “a shift to alternative residential models”. CLBC hopes for savings of $7 million from the ROP, which would be commendable if the intent was to promote meaningful choice as promised. But "the success of the Residential Options Project,” according to CLBC, “will be determined by: number of individuals choosing to pursue an alternative residential model...”

These documents all point to one conclusion. That the policies driving community living residential reforms and the intentions of the ROP are inconsistent with commitments made. This is deeply disturbing and raises grave concern about the safety and wellbeing of current and future residents.

Available evidence suggests this approach will not support a successful transformation, create a more sustainable system or allow CLBC to meet the urgent needs of the thousands on waitlists. CLBC’s recently commissioned literature review by UBC Prof. Tim Stainton, titled “Residential Options for Adults with Developmental Disabilities: Quality and Cost Outcomes”, found no clear evidence that alternatives being promoted are less costly than group homes. Secondly, the shift underway assumes that moving from primarily unionised to non-union models will produce savings, due to the significant differential in pay rates currently for unionized and non-union caregivers. But the rising outcry from non-union operators facing a growing recruitment and retention crisis suggest this strategy is doomed in the current tight labour market. Thirdly, as CLBC notes in the new Service Plan, growing community unease threatens to undermine broader restructuring, scuttling efforts that could provide cost efficiencies along with better service for some people, for example, respite and/or Individualized Funding:

“Loss of support from individuals, families and communities could compromise CLBC’s service re-design and reduce the effectiveness of initiatives to improve resource utilization and introduce such innovations as individualized funding. Inability to properly fund person-centred plans or provide respite support may increase the utilization of more expensive resources in response to crisis.”

BC FamilyNet reflects the views of most families and the broader community in stating that group homes are neither a more suitable nor a less suitable model for community living. They are not inherently more or less person-centred and there is no evidence that they are either more or less costly than alternatives. This is a model that, when properly managed and supervised, works very well for some people. The same applies to a range of other models and we fully support the development of other options. Meaningful choice is not a privilege in community living; it is a fundamental requirement, because of the diversity of the individuals served and the varied circumstances of individuals and families across the province.

However, the feedback we receive indicates this review has stirred deep mistrust in the community. The mid-point assessment shows the vast majority of individuals and families did not even agree to consider other options, although there is unquestionable concern over the quality of service in some group homes. Done right, this review could accomplish much good, especially if residents of other models and those on waitlists are also surveyed about their residential preferences. This would provide invaluable data to aid planning and service redesign. Some current residents of group homes or other models may indeed be happier in alternate settings. Savings without loss of quality/security are possible. The ROP could also identify quality/management gaps requiring attention and aid in development of effective safeguards. 

However, community support for the ROP and/or broader reforms requires several missing ingredients:


Continuing under-funding of CLBC in 2007-08 will make it almost impossible to resolve these barriers to successful transformation. Flaws and flawed assumptions in the new CLBC model create further obstacles to success and are adding to the credibility gap between promise and reality. We reiterate the need for a serious adjustment to the current approach in order to restore confidence and to stop the restructuring process getting further off-track, and we continue to offer our support to aid you and CLBC in that regard.
Sincerely

Anita Dadson, President
BC FamilyNet

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