Disabled Adults in New Jersey

The Record has a series on the care of disabled adults in New Jersey.

Today's report focuses on the state's reliance on big institutions instead of community care.

There’s a lot of evidence backing up that assessment:

• Nearly 8,000 disabled adults are on a waiting list for services ranging from training to group homes; they live at home, often cared for by aged parents.
• It costs on average $100,000 more a year to care for someone at a developmental center than it does to care for people with the same level of disability in the community, the state estimates.
• New Jersey’s rate of institutionalization is higher than all but two other states: Mississippi and Arkansas. Nearly one in five of the more than 14,000 individuals who are provided with residences live in large state institutions.
• The Division of Developmental Disabilities spends just about a third of its $1.5 billion operating budget on those institutions, even though they are home to just 6 percent of disabled adults in New Jersey. Only Texas, Mississippi and Louisiana spend a smaller share of their disability services budgets on community programs.

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The state has perhaps a more fundamental reason to expand its community services: In 1999, the U.S. Supreme Court ruled that the federal Americans With Disabilities Act requires states to provide the disabled with the most appropriate services possible in the least restrictive setting. Disability Rights New Jersey, a Trenton advocacy group, has filed two federal lawsuits against the state, arguing that both the waiting list and the large number of disabled individuals still institutionalized violate the Supreme Court ruling.

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Caring for more of the disabled in the community would almost unquestionably reduce costs for the Division of Developmental Disabilities. But some question how much savings will actually be realized.

One researcher who analyzed a series of national studies [the 2003 literature review is here] on the costs of serving the developmentally disabled pointed out that a community system just shifts some expenses from one arm of government to another.

Instead of seeing a doctor who’s on the institution’s staff, for example, clients will go to physicians in the community.

“You’re just flopping the cost over to Medicaid,” noted Kevin Walsh, director of quality and management at the Developmental Disabilities Health Alliance in Gloucester.

But there is one area of real savings for the state, Walsh noted: Direct-care workers in the community are paid significantly lower salaries and pensions than their unionized counterparts at the state developmental centers.